Scan-Negative Cauda Equina Syndrome: A Prospective Cohort Study
OBJECTIVE:To describe clinical features relevant to diagnosis, mechanism and aetiology in patients with ‘scan-negative’ cauda equina syndrome (CES). METHODS:We carried out a prospective study of consecutive patients presenting with the clinical features of CES to a regional neurosurgery centre compr...
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| Veröffentlicht in: | Neurology 2021-01, Vol.96 (3), p.e433-e447 |
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| container_title | Neurology |
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| creator | Hoeritzauer, Ingrid Carson, Alan Statham, Patrick Panicker, Jalesh N. Granitsiotis, Voula Eugenicos, Maria Summers, David Demetriades, Andreas K. Stone, Jon |
| description | OBJECTIVE:To describe clinical features relevant to diagnosis, mechanism and aetiology in patients with ‘scan-negative’ cauda equina syndrome (CES).
METHODS:We carried out a prospective study of consecutive patients presenting with the clinical features of CES to a regional neurosurgery centre comprising semi-structured interview and questionnaires investigating presenting symptoms, neurological examination, psychiatric and functional disorder comorbidity, bladder/bowel/sexual function, distress and disability.
RESULTS:198 patients presented consecutively over 28 months. 47 were diagnosed with ‘scan-positive’ CES (mean age 48yrs, 43% female). 76 ‘mixed’ category patients had nerve root compression/displacement without CES compression, (mean age 46yrs, 71% female) and 61 patients had ‘scan-negative’ CES (mean age 40yrs, 77% female). An alternative neurological cause of CES emerged in 14/198 patients during admission and 4/151 patients with mean duration 25 months follow up.Patients with ‘scan-negative’ CES had more positive clinical signs of a functional neurological disorder (11%‘scan positive’ CES v. 34%mixed and 68%‘scan-negative’, p |
| doi_str_mv | 10.1212/WNL.0000000000011154 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2460085388</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2460085388</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3504-99119ec047ecb5fa133e84105479713e06920820c5d8e0b6b9ee50284c912ce63</originalsourceid><addsrcrecordid>eNqFkE1PwkAQhjdGI4j-A2N69FLc2Y9214shBD8SgiZo9NYs20GqpYXdVsK_twTUxIPOZS7P887kJeQUaBcYsIvn0bBLfwYApNgjbZAsCiPOXvZJm1KmQq5i1SJH3r81kGSxPiQtziGOGYM2uRpbU4QjfDVV9oFB39SpCQbLOitMMF4XqSvneBn0ggdX-gXaLVTOSlcF46pO18fkYGpyjye73SFP14PH_m04vL-56_eGoeWSilBrAI2WihjtRE4NcI5KAJUi1jFwpJFmVDFqZaqQTqKJRpTN98JqYBYj3iHn29yFK5c1-iqZZ95inpsCy9onTESUKsmValCxRW3zs3c4TRYumxu3ToAmm-qSprrkd3WNdra7UE_mmH5LX101gNoCqzKv0Pn3vF6hS2Zo8mr2X7b4Q91wEYAIGWXQGJqGG1PwT8VTh3c</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2460085388</pqid></control><display><type>article</type><title>Scan-Negative Cauda Equina Syndrome: A Prospective Cohort Study</title><source>MEDLINE</source><source>Alma/SFX Local Collection</source><source>Journals@Ovid Complete</source><creator>Hoeritzauer, Ingrid ; Carson, Alan ; Statham, Patrick ; Panicker, Jalesh N. ; Granitsiotis, Voula ; Eugenicos, Maria ; Summers, David ; Demetriades, Andreas K. ; Stone, Jon</creator><creatorcontrib>Hoeritzauer, Ingrid ; Carson, Alan ; Statham, Patrick ; Panicker, Jalesh N. ; Granitsiotis, Voula ; Eugenicos, Maria ; Summers, David ; Demetriades, Andreas K. ; Stone, Jon</creatorcontrib><description>OBJECTIVE:To describe clinical features relevant to diagnosis, mechanism and aetiology in patients with ‘scan-negative’ cauda equina syndrome (CES).
METHODS:We carried out a prospective study of consecutive patients presenting with the clinical features of CES to a regional neurosurgery centre comprising semi-structured interview and questionnaires investigating presenting symptoms, neurological examination, psychiatric and functional disorder comorbidity, bladder/bowel/sexual function, distress and disability.
RESULTS:198 patients presented consecutively over 28 months. 47 were diagnosed with ‘scan-positive’ CES (mean age 48yrs, 43% female). 76 ‘mixed’ category patients had nerve root compression/displacement without CES compression, (mean age 46yrs, 71% female) and 61 patients had ‘scan-negative’ CES (mean age 40yrs, 77% female). An alternative neurological cause of CES emerged in 14/198 patients during admission and 4/151 patients with mean duration 25 months follow up.Patients with ‘scan-negative’ CES had more positive clinical signs of a functional neurological disorder (11%‘scan positive’ CES v. 34%mixed and 68%‘scan-negative’, p<0.0001), were more likely to describe their current back pain as ‘worst ever’ (41% vs. 46% and 70%, p=0.005) and have symptoms of a panic attack at onset (37% vs. 57% and 70%, p=0.001). Patients with ‘scan positive’ CES were more likely to have reduced/absent bilateral ankle jerks (78% ‘vs. 30% and 12%, p=<0.0001). There was no significant difference between groups in the frequency of reduced anal tone and urinary retention.
CONCLUSIONS:The first well phenotyped, prospective study of ‘scan-negative’ CES supports a model in which acute pain, medication, and mechanisms overlapping with functional neurological disorder may be relevant.</description><identifier>ISSN: 0028-3878</identifier><identifier>EISSN: 1526-632X</identifier><identifier>DOI: 10.1212/WNL.0000000000011154</identifier><identifier>PMID: 33177221</identifier><language>eng</language><publisher>United States: Lippincott Williams & Wilkins</publisher><subject>Adult ; Cauda Equina Syndrome - complications ; Cauda Equina Syndrome - diagnosis ; Cauda Equina Syndrome - physiopathology ; Disability Evaluation ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Neuroimaging ; Prospective Studies ; Sexual Dysfunction, Physiological - etiology ; Sexual Dysfunction, Physiological - physiopathology ; Surveys and Questionnaires ; Urinary Retention - etiology ; Urinary Retention - physiopathology</subject><ispartof>Neurology, 2021-01, Vol.96 (3), p.e433-e447</ispartof><rights>Lippincott Williams & Wilkins</rights><rights>2020 American Academy of Neurology</rights><rights>2020 American Academy of Neurology.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c3504-99119ec047ecb5fa133e84105479713e06920820c5d8e0b6b9ee50284c912ce63</cites><orcidid>0000-0002-7425-0964 ; 0000-0002-5604-3312 ; 0000-0002-3365-046X ; 0000-0001-9829-8092 ; 0000-0002-2004-9448 ; 0000-0001-5190-3259 ; 0000-0001-6742-7197</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33177221$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hoeritzauer, Ingrid</creatorcontrib><creatorcontrib>Carson, Alan</creatorcontrib><creatorcontrib>Statham, Patrick</creatorcontrib><creatorcontrib>Panicker, Jalesh N.</creatorcontrib><creatorcontrib>Granitsiotis, Voula</creatorcontrib><creatorcontrib>Eugenicos, Maria</creatorcontrib><creatorcontrib>Summers, David</creatorcontrib><creatorcontrib>Demetriades, Andreas K.</creatorcontrib><creatorcontrib>Stone, Jon</creatorcontrib><title>Scan-Negative Cauda Equina Syndrome: A Prospective Cohort Study</title><title>Neurology</title><addtitle>Neurology</addtitle><description>OBJECTIVE:To describe clinical features relevant to diagnosis, mechanism and aetiology in patients with ‘scan-negative’ cauda equina syndrome (CES).
METHODS:We carried out a prospective study of consecutive patients presenting with the clinical features of CES to a regional neurosurgery centre comprising semi-structured interview and questionnaires investigating presenting symptoms, neurological examination, psychiatric and functional disorder comorbidity, bladder/bowel/sexual function, distress and disability.
RESULTS:198 patients presented consecutively over 28 months. 47 were diagnosed with ‘scan-positive’ CES (mean age 48yrs, 43% female). 76 ‘mixed’ category patients had nerve root compression/displacement without CES compression, (mean age 46yrs, 71% female) and 61 patients had ‘scan-negative’ CES (mean age 40yrs, 77% female). An alternative neurological cause of CES emerged in 14/198 patients during admission and 4/151 patients with mean duration 25 months follow up.Patients with ‘scan-negative’ CES had more positive clinical signs of a functional neurological disorder (11%‘scan positive’ CES v. 34%mixed and 68%‘scan-negative’, p<0.0001), were more likely to describe their current back pain as ‘worst ever’ (41% vs. 46% and 70%, p=0.005) and have symptoms of a panic attack at onset (37% vs. 57% and 70%, p=0.001). Patients with ‘scan positive’ CES were more likely to have reduced/absent bilateral ankle jerks (78% ‘vs. 30% and 12%, p=<0.0001). There was no significant difference between groups in the frequency of reduced anal tone and urinary retention.
CONCLUSIONS:The first well phenotyped, prospective study of ‘scan-negative’ CES supports a model in which acute pain, medication, and mechanisms overlapping with functional neurological disorder may be relevant.</description><subject>Adult</subject><subject>Cauda Equina Syndrome - complications</subject><subject>Cauda Equina Syndrome - diagnosis</subject><subject>Cauda Equina Syndrome - physiopathology</subject><subject>Disability Evaluation</subject><subject>Female</subject><subject>Humans</subject><subject>Magnetic Resonance Imaging</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Neuroimaging</subject><subject>Prospective Studies</subject><subject>Sexual Dysfunction, Physiological - etiology</subject><subject>Sexual Dysfunction, Physiological - physiopathology</subject><subject>Surveys and Questionnaires</subject><subject>Urinary Retention - etiology</subject><subject>Urinary Retention - physiopathology</subject><issn>0028-3878</issn><issn>1526-632X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkE1PwkAQhjdGI4j-A2N69FLc2Y9214shBD8SgiZo9NYs20GqpYXdVsK_twTUxIPOZS7P887kJeQUaBcYsIvn0bBLfwYApNgjbZAsCiPOXvZJm1KmQq5i1SJH3r81kGSxPiQtziGOGYM2uRpbU4QjfDVV9oFB39SpCQbLOitMMF4XqSvneBn0ggdX-gXaLVTOSlcF46pO18fkYGpyjye73SFP14PH_m04vL-56_eGoeWSilBrAI2WihjtRE4NcI5KAJUi1jFwpJFmVDFqZaqQTqKJRpTN98JqYBYj3iHn29yFK5c1-iqZZ95inpsCy9onTESUKsmValCxRW3zs3c4TRYumxu3ToAmm-qSprrkd3WNdra7UE_mmH5LX101gNoCqzKv0Pn3vF6hS2Zo8mr2X7b4Q91wEYAIGWXQGJqGG1PwT8VTh3c</recordid><startdate>20210119</startdate><enddate>20210119</enddate><creator>Hoeritzauer, Ingrid</creator><creator>Carson, Alan</creator><creator>Statham, Patrick</creator><creator>Panicker, Jalesh N.</creator><creator>Granitsiotis, Voula</creator><creator>Eugenicos, Maria</creator><creator>Summers, David</creator><creator>Demetriades, Andreas K.</creator><creator>Stone, Jon</creator><general>Lippincott Williams & Wilkins</general><general>American Academy of Neurology</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-7425-0964</orcidid><orcidid>https://orcid.org/0000-0002-5604-3312</orcidid><orcidid>https://orcid.org/0000-0002-3365-046X</orcidid><orcidid>https://orcid.org/0000-0001-9829-8092</orcidid><orcidid>https://orcid.org/0000-0002-2004-9448</orcidid><orcidid>https://orcid.org/0000-0001-5190-3259</orcidid><orcidid>https://orcid.org/0000-0001-6742-7197</orcidid></search><sort><creationdate>20210119</creationdate><title>Scan-Negative Cauda Equina Syndrome: A Prospective Cohort Study</title><author>Hoeritzauer, Ingrid ; Carson, Alan ; Statham, Patrick ; Panicker, Jalesh N. ; Granitsiotis, Voula ; Eugenicos, Maria ; Summers, David ; Demetriades, Andreas K. ; Stone, Jon</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3504-99119ec047ecb5fa133e84105479713e06920820c5d8e0b6b9ee50284c912ce63</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Adult</topic><topic>Cauda Equina Syndrome - complications</topic><topic>Cauda Equina Syndrome - diagnosis</topic><topic>Cauda Equina Syndrome - physiopathology</topic><topic>Disability Evaluation</topic><topic>Female</topic><topic>Humans</topic><topic>Magnetic Resonance Imaging</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Neuroimaging</topic><topic>Prospective Studies</topic><topic>Sexual Dysfunction, Physiological - etiology</topic><topic>Sexual Dysfunction, Physiological - physiopathology</topic><topic>Surveys and Questionnaires</topic><topic>Urinary Retention - etiology</topic><topic>Urinary Retention - physiopathology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Hoeritzauer, Ingrid</creatorcontrib><creatorcontrib>Carson, Alan</creatorcontrib><creatorcontrib>Statham, Patrick</creatorcontrib><creatorcontrib>Panicker, Jalesh N.</creatorcontrib><creatorcontrib>Granitsiotis, Voula</creatorcontrib><creatorcontrib>Eugenicos, Maria</creatorcontrib><creatorcontrib>Summers, David</creatorcontrib><creatorcontrib>Demetriades, Andreas K.</creatorcontrib><creatorcontrib>Stone, Jon</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Neurology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hoeritzauer, Ingrid</au><au>Carson, Alan</au><au>Statham, Patrick</au><au>Panicker, Jalesh N.</au><au>Granitsiotis, Voula</au><au>Eugenicos, Maria</au><au>Summers, David</au><au>Demetriades, Andreas K.</au><au>Stone, Jon</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Scan-Negative Cauda Equina Syndrome: A Prospective Cohort Study</atitle><jtitle>Neurology</jtitle><addtitle>Neurology</addtitle><date>2021-01-19</date><risdate>2021</risdate><volume>96</volume><issue>3</issue><spage>e433</spage><epage>e447</epage><pages>e433-e447</pages><issn>0028-3878</issn><eissn>1526-632X</eissn><abstract>OBJECTIVE:To describe clinical features relevant to diagnosis, mechanism and aetiology in patients with ‘scan-negative’ cauda equina syndrome (CES).
METHODS:We carried out a prospective study of consecutive patients presenting with the clinical features of CES to a regional neurosurgery centre comprising semi-structured interview and questionnaires investigating presenting symptoms, neurological examination, psychiatric and functional disorder comorbidity, bladder/bowel/sexual function, distress and disability.
RESULTS:198 patients presented consecutively over 28 months. 47 were diagnosed with ‘scan-positive’ CES (mean age 48yrs, 43% female). 76 ‘mixed’ category patients had nerve root compression/displacement without CES compression, (mean age 46yrs, 71% female) and 61 patients had ‘scan-negative’ CES (mean age 40yrs, 77% female). An alternative neurological cause of CES emerged in 14/198 patients during admission and 4/151 patients with mean duration 25 months follow up.Patients with ‘scan-negative’ CES had more positive clinical signs of a functional neurological disorder (11%‘scan positive’ CES v. 34%mixed and 68%‘scan-negative’, p<0.0001), were more likely to describe their current back pain as ‘worst ever’ (41% vs. 46% and 70%, p=0.005) and have symptoms of a panic attack at onset (37% vs. 57% and 70%, p=0.001). Patients with ‘scan positive’ CES were more likely to have reduced/absent bilateral ankle jerks (78% ‘vs. 30% and 12%, p=<0.0001). There was no significant difference between groups in the frequency of reduced anal tone and urinary retention.
CONCLUSIONS:The first well phenotyped, prospective study of ‘scan-negative’ CES supports a model in which acute pain, medication, and mechanisms overlapping with functional neurological disorder may be relevant.</abstract><cop>United States</cop><pub>Lippincott Williams & Wilkins</pub><pmid>33177221</pmid><doi>10.1212/WNL.0000000000011154</doi><orcidid>https://orcid.org/0000-0002-7425-0964</orcidid><orcidid>https://orcid.org/0000-0002-5604-3312</orcidid><orcidid>https://orcid.org/0000-0002-3365-046X</orcidid><orcidid>https://orcid.org/0000-0001-9829-8092</orcidid><orcidid>https://orcid.org/0000-0002-2004-9448</orcidid><orcidid>https://orcid.org/0000-0001-5190-3259</orcidid><orcidid>https://orcid.org/0000-0001-6742-7197</orcidid></addata></record> |
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| subjects | Adult Cauda Equina Syndrome - complications Cauda Equina Syndrome - diagnosis Cauda Equina Syndrome - physiopathology Disability Evaluation Female Humans Magnetic Resonance Imaging Male Middle Aged Neuroimaging Prospective Studies Sexual Dysfunction, Physiological - etiology Sexual Dysfunction, Physiological - physiopathology Surveys and Questionnaires Urinary Retention - etiology Urinary Retention - physiopathology |
| title | Scan-Negative Cauda Equina Syndrome: A Prospective Cohort Study |
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