Urinary retention for the neurologist

Smith, Matthew D; Seth, Jai; Fowler, Clare J.; Miller, R F; Panicker, Jalesh N.

doi:10.1136/practneurol-2012-000478

Cited by 13 publications

(7 citation statements)

References 19 publications

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“…Co-existent sexual and bowel complaints, and the findings of an abnormal anal sphincter EMG, would suggest a neurological cause for urinary retention with likely localisation at the sacral spinal cord or nerve roots [8,18]. Orthostatic hypotension was present in some of the patients at an early stage, and a peripheral autonomic disorder such as pure autonomic failure (PAF) may have been considered in the differential diagnosis; however, the anal sphincter EMG is reported to be normal in this condition [15,19].…”

Section: Discussionmentioning

confidence: 99%

Early presentation of urinary retention in multiple system atrophy: can the disease begin in the sacral spinal cord?

et al. 2019

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Lower urinary tract (LUT) dysfunction presents early in multiple system atrophy (MSA), usually initially as urinary urgency, frequency and incontinence, and voiding difficulties/urinary retention becomes apparent over time. We have observed a subset of patients who instead presented initially with urinary retention requiring catheterisation. At presentation, these patients had only subtle neurological signs that would not fulfil the diagnostic criteria of MSA; however, the anal sphincter electromyography (EMG) was abnormal and they reported bowel and sexual dysfunction, suggesting localisation at the level of the sacral spinal cord. They subsequently developed classical neurological signs, meeting the diagnostic criteria for probable MSA. One patient was confirmed to have MSA at autopsy. We postulate that in a subset of patients with MSA, the disease begins in the sacral spinal cord and then spreads to other regions resulting in the classical signs of MSA. The transmissibility of alpha-synuclein has been demonstrated in animal models and the spread of pathology from sacral cord to other regions of the central nervous system is therefore plausible. Patients presenting with urinary retention and mild neurological features would be an ideal group for experimental trials evaluating neuroprotection in MSA

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Section: Discussionmentioning

confidence: 99%

Early presentation of urinary retention in multiple system atrophy: can the disease begin in the sacral spinal cord?

et al. 2019

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“…31 In general, urinary retention is considered a supportive symptom for myelopathy. 32,33 Secondly, the absence of abdominal reflexes were described in one patient (case 1). Although this may be indicative of TM, abdominal reflexes are absent in 20% of normal individuals, in particular in those with lax abdominal tone, obesity, women who have borne children and elderly.…”

Section: Dovepressmentioning

confidence: 96%

Suspected Transverse Myelitis with Normal MRI and CSF Findings in a Patient with Lupus: What to Do? A Case Series and Systematic Review

Monahan

Beaart

Fronczek

et al. 2020

NDT

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Purpose To evaluate the use of immunosuppressive treatment, clinical outcome and diagnostic strategy in patients with systemic lupus erythematosus (SLE) presenting with clinical features of transverse myelitis (TM), but normal MRI of the spinal cord (sMRI) and normal cerebrospinal fluid (CSF) assessment, and to suggest a clinical guideline. Patients and Methods All patients with SLE and clinical features compatible with (sub)acute TM visiting the NPSLE clinic of the LUMC between 2007 and 2020 were included. Information on baseline characteristics, investigations, treatment and outcomes was collected from electronic medical records. In addition, a systematic review of individual participant data was performed up to April 2020 in PubMed, Embase and Web of Science, identifying all patients with TM, SLE and sMRI assessment. Data regarding sMRI, CSF analysis, treatment and outcome were extracted, and outcome was compared between patients with normal sMRI and CSF (sMRI-/CSF-) and patients with abnormalities. Results Twelve SLE patients with a clinical diagnosis of TM were identified: four sMRI-/CSF- and one sMRI- with CSF not available. All patients received immunosuppressive treatment, but outcome in sMRI-/CSF- patients was worse: no recovery (n=1) or partial recovery (n=3) compared to partial recovery (n=4) and (nearly) complete recovery (n=3) in MRI+ patients. The systematic literature review yielded 146 articles eligible for inclusion, 90% case reports. A total of 427 SLE patients with TM were identified, of which only four cases were sMRI-/CSF- (1%), showing no improvement (n=1), partial improvement (n=2) and complete recovery (n=1) after immunosuppressive treatment. Conclusion Outcome in SLE patients presenting with clinically suspected TM with normal sMRI and CSF is less favorable, despite treatment with immunosuppressive therapy. Taking a functional neurological disorder into consideration may be helpful in order to start other therapeutic strategies. We suggest prescribing immunosuppressive treatment for a restricted period of time to evaluate its effect in cases where a functional disorder initially is considered unlikely.

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“…The presence of neurological deficits in the lower limbs may indicate a spinal or nerve root lesion. When the neurological examination is normal, the diagnosis is dependent on further testing 18 …”

Section: Discussionmentioning

confidence: 99%

Urine retention as presenting manifestation of tuberculous meningitis complicated by lacunar infarction and transverse myelitis: Case report and literature review

Abdulhadi

Abdelmahmuod

Al-Rubaiei

et al. 2021

Clinical Case Reports

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Urinary retention for the neurologist

Cited by 13 publications

References 19 publications

Early presentation of urinary retention in multiple system atrophy: can the disease begin in the sacral spinal cord?

Early presentation of urinary retention in multiple system atrophy: can the disease begin in the sacral spinal cord?

Suspected Transverse Myelitis with Normal MRI and CSF Findings in a Patient with Lupus: What to Do? A Case Series and Systematic Review

Urine retention as presenting manifestation of tuberculous meningitis complicated by lacunar infarction and transverse myelitis: Case report and literature review

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