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An Unusual Cause of Cauda Equina Syndrome: Lumbar Epidural Venous Engorgement.
AlTahan, Husam A; Amer, Roaa R; Madani, Areej A; Bakhsh, Eman A.
Affiliation
  • AlTahan HA; College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
  • Amer RR; College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
  • Madani AA; College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
  • Bakhsh EA; Department of Neuroradiology, King Fahad Medical City, Riyadh, Saudi Arabia.
Am J Case Rep ; 19: 694-698, 2018 Jun 15.
Article in En | MEDLINE | ID: mdl-29904039
ABSTRACT
BACKGROUND Epidural venous plexus (EVP) engorgement occurs due to many conditions, so it can be easily misdiagnosed. This becomes problematic when the diagnosis requires prompt treatment for a good outcome, especially when it results in cauda equina syndrome (CES). We report a case of extensive iliocaval thrombosis leading to epidural venous plexus and ascending lumbar vein engorgement as an outcome of deep venous thrombosis (DVT) due to probable adverse effects of oral combined contraceptive pills (OCCP). CASE REPORT A 42-year-old woman presented to a rural medical facility with bilateral lower-limb swelling and skin darkening for 2 days. She was transferred to a tertiary medical facility where her condition deteriorated to severe CES. A lower-limbs ultrasonography confirmed the presence of extensive DVT extending to the lower segment of the inferior vena cava. Spine magnetic resonance imaging showed abnormal enhancement of the conus medullaris with thick enhanced cauda equina nerve roots, consistent with a possible case of Guillain-Barré syndrome. However, there was engorgement of the EVP extending to the ascending lumbar, azygos, and hemiazygos veins, which was misdiagnosed. The patient was managed immediately with low-molecular-weight heparin and steroids. She died 4 weeks after admission due to hospital-acquired pneumonia and acute respiratory distress syndrome, probably due to the high dose of steroids. CONCLUSIONS Acute CES has a wide differential diagnosis. This report describes an unusual cause of CES and emphasizes the importance of early recognition to avoid misdiagnosis and management delay. Early identification of this clinical entity markedly decreases morbidity and mortality and thus improves the prognosis. Likewise, underlying causing factors such as venous congestion due to OCCP-related DVT should be considered in the diagnosis.
Subject(s)

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Polyradiculopathy / Contraceptives, Oral, Combined / Venous Thrombosis Type of study: Prognostic_studies Limits: Adult / Female / Humans Language: En Journal: Am J Case Rep Year: 2018 Document type: Article Affiliation country: Saudi Arabia

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Polyradiculopathy / Contraceptives, Oral, Combined / Venous Thrombosis Type of study: Prognostic_studies Limits: Adult / Female / Humans Language: En Journal: Am J Case Rep Year: 2018 Document type: Article Affiliation country: Saudi Arabia