Cauda Equina Syndrome Research Articles

Machine learning in predicting cauda equina imaging outcomes- a solution to the problem.

Cauda Equina Syndrome (CES) is a rare surgical emergency. The implications for loss of quality of life through delayed management are high, though no clinical symptom is pathognomonic in its diagnosis. We describe how machine learning based algorithms can be used in triaging patients with suspected CES (CES-S). Data of 499 patients who underwent MRI scan for CES-S was collected for demographics, red flag symptoms and radiological outcome. The dataset was used to train the machine learning algorithm in predicting MRI-derived diagnosis of CES. In the testing phase output predictions and Confidence of Prediction (CoP) were recorded for each case and further analysed. Of 499 patients, 12 (2.4%) had positive radiological outcomes for CES. Patients were divided into two subgroups based on their CoP: high (< 0.9) and low (< 0.9). High CoP was observed in 482 (96.6%) cases. In this group all predictions were correct: 476 negative and 6 positives. Low CoP was observed in 17 (3.4%) cases, of which 6 predictions were incorrect - false negatives. Performing MRI scans only in cases with high CoP positive predictions and all low CoP cases would reduce scans to 5% of the original number. With our dataset, the trained algorithm demonstrated the potential for safely reducing the number of emergency MRI scans by over 95%. Prior to the wide clinical application, large volume prospective data is needed for continuous training of the algorithm, in order to improve accuracy and confidence of prediction.

Lumbar disc herniation

The most common cause of disc herniation is the degeneration of the intervertebral disc. Consequently, lumbar disc herniations are amongst the most common pathologies of the lumbar spine. Factors that can increase the risk of disc herniation include genetics, weight, occupational risk factors, smoking, as well as apredominantly sedentary profession. Pathognomonic symptoms of aherniated disc include sciatica, caused by the compression of one or more spinal nerve roots. The clinical sequelae of lumbar disc herniations range from mild low back and buttock pain to severe, immobilising cases of sciatica to cauda equina compression syndromes. In 1-1.5% of cases, acauda equina syndrome may occur. This cauda equina syndrome may be considered an emergency situation that requires immediate attention and surgical decompression. The same applies to significant and rapidly deteriorating neurological deficits (< 24 h). In all other cases, which represents the majority of all patients,substantial pain relief can be achieved with nonsurgical measures. If an adequate and intolerable pain relief cannot be achieved despite intense conservative treatment measures after an extended period of 6-12weeks, surgical removal of the disc herniation may be indicated. Lumbar disc herniations may be addressed surgically with minimally invasive techniques. The goal of the surgery is full and sufficient safe removal of the herniated disc fragments in order to decompress the spinal nerves as well as the cauda equina. The two most commonly used surgical techniques (endoscopic/microsurgical) entail fivedifferent approaches (endoscopic: interlaminar, transforaminal; microsurgical: interlaminar, translaminar, extraforaminal). Patients are generally fully mobilized within hours after the surgery without any further restrictions. Postoperative rehabilitation measures are often carried out, but have no scientifically proven influence on the outcome of the operation. This article sheds light on the diagnostic and therapeutic procedures, techniques and special features of this socio-medically very important clinical picture.

Spinal Metastases in Non-Seminomatous Germ Cell Testicular Tumors: Prognosis and Integrated Therapeutic Approaches—A Systematic Review with an Institutional Case Illustration

(1) Background: Testicular cancer, although accounting for only 0.5% to 1% of all solid male cancers, is the most common malignancy in males aged 15 to 35 years. Non-seminomatous germ cell tumors (NSGCT) represent nearly half of all testicular germ cell tumors and are associated with a more aggressive clinical course. Spinal metastases, while rare, pose significant challenges due to their potential to cause spinal cord compression, neurological deficits, and severe pain. This systematic review aims to evaluate prognosis and treatment approaches for spinal metastases in NSGCT, with a focus on multidisciplinary care and treatment outcomes. (2) Methods: A systematic review was conducted following PRISMA guidelines. PubMed, Scopus, and Embase were searched on 18 September 2024, using the Boolean search strategy [(Nonseminomatous germ cell tumor (NSGCT) AND (spinal OR vertebral metastases)]. Case reports, case series, and cohort studies providing detailed patient data were included. Data on patient demographics, tumor histology, metastatic site, treatments, and outcomes were extracted for analysis. (3) Results: A total of 164 cases of NSGCT with spinal metastases were analyzed, with patients aged 23 to 40 years (median: 31.5 years). The lumbar spine was involved in all cases, and spinal cord compression occurred in 59.8% of patients, often causing severe neurological symptoms such as cauda equina syndrome. Chemotherapy, primarily cisplatin-based, was administered in all cases, while surgical interventions, including laminectomy and vertebrectomy, were performed in cases of spinal compression and instability. Complete remission occurred in only 2.4% of patients. Progressive improvement was observed in 56.7% of cases, while 20.1% of patients died. Outcomes varied, highlighting the importance of individualized, multidisciplinary care to manage both systemic and localized disease. (4) Conclusions: Spinal metastases in NSGCT represent a complex clinical scenario, requiring a combination of chemotherapy, surgery, and in some cases, radiotherapy. Chemotherapy remains essential, but surgery is critical for addressing spinal compression and instability. A multidisciplinary approach is vital for optimizing outcomes, as prognosis is variable, with some patients achieving improvement while others face progressive disease or death. Further research is needed to refine the role of radiotherapy and improve long-term treatment strategies for this rare complication.

An acute bleeding metastatic spinal tumor from HCC causes an acute onset of cauda equina syndrome

An acute bleeding metastatic spinal tumor from HCC causes an acute onset of cauda equina syndrome

An unusual late complication of peridural anesthesia: The case of a subdural spinal epidermoid cyst: A case report and literature review

The peridural approach is primarily used today to provide analgesia in obstetrics and postoperative care. Peridural analgesia is not only more effective than systemic analgesia, but it also has benefits in terms of morbidity, particularly regarding postoperative respiratory complications and the shortened duration of postoperative ileus. Unlike dural tears, immediate and severe neurological complications such as hematomas or abscesses are very rare. Long-term sequelae are less well known because the relationship with epidural analgesia performed several months or years earlier is not always well established. We report a rare case of a 35-year-old patient with a history of epidural anesthesia five years ago during childbirth, who was admitted with cauda equina syndrome. MRI (magnetic resonance imaging) of the lumbar spine showed a subdural lesion at the level of L3. The patient underwent resection of the lesion, and the pathological examination of the surgical specimen concluded it was an epidermoid cyst.

Neuro-leishmaniasis with cauda equina syndrome and cranial nerve palsy: a rare manifestation of recurrent atypical visceral leishmaniasis

BackgroundVisceral leishmaniasis (VL) is a neglected tropical disease primarily affecting Brazil, East Africa, and India, with India accounting for 18% of the global burden. While VL typically presents with systemic symptoms like fever, weight loss, and splenomegaly, it can occasionally manifest atypically, posing significant diagnostic challenges. Neurological presentations of VL are extremely rare, making them difficult to suspect and diagnose. Cases where VL predominantly presents with neurological symptoms are particularly novel, underscoring the need for heightened awareness of such atypical manifestations in endemic regions.Clinical caseA 38-year-old man with history of recurrent atypical VL presented with diffuse lower back pain, progressive tingling, numbness, weakness in the lower extremities, and double vision for one month. Clinical and radiological evaluations suggested cauda equina syndrome and cranial nerve palsy, accompanied by generalized lymphadenopathy, subcutaneous nodules, and skin papules. The differential diagnosis initially included disseminated tuberculosis, histoplasmosis, and lymphoma. Cerebrospinal fluid (CSF) analysis revealed an inflammatory syndrome. Histopathology of lymph node and bone marrow revealed Leishmania amastigotes and subcutaneous nodule and skin biopsy revealed inflammatory cells with granulomas. Furthermore, the qPCR test on DNA from a subcutaneous nodule, lymph node, and CSF was positive for Leishmania kinetoplast DNA. The species was further confirmed as Leishmania donovani through ITS-based PCR amplification and sequencing. Finally, a diagnosis of relapse of VL with lymph node, cutaneous, and neurological involvement, including abducens nerve palsy and cauda equina syndrome, was established. He was treated with combination of liposomal amphotericin B and miltefosine, along with intrathecal hyaluronidase, resulting in significant improvement.ConclusionUnlike previously reported cases with both systemic and neurological symptoms, our patient predominantly presented with neurological manifestations, making this a unique and novel presentation of VL. This case highlights diagnostic challenges and management of atypical VL, emphasizing neurological involvement and successful therapeutic strategies.

A conservative management approach for spinal tuberculosis causing cauda equine syndrome in pregnancy

Background: Spinal tuberculosis in pregnancy leading to neurological sequelae is rare and a challenging condition to manage. The usual approach is to perform urgent decompression surgery, but patients with a more stable course of the disease may benefit from a conservative approach with anti-tuberculosis (ATT) therapy.Case presentation: A pregnant mother in her second trimester presented with a history of chronic backache exacerbated by right-sided foot drop, L5 root sensory loss and intermittent urinary retention. MRI revealed L5 vertebral collapse with para-vertebral collection causing cauda equine compression at the L5-S1 level. High ESR, strongly positive tuberculin test, and the clinical and radiological findings were compatible with a diagnosis of spinal tuberculosis. Based on the multi-disciplinary team’s decision, a conservative management approach with ATT and supportive therapy was initiated with close observation. The patient showed a remarkable response to ATT with clinical and radiological improvement. She underwent an elective caesarean section at 37 weeks and delivered a healthy baby. On the fourth week postpartum, she underwent decompressive surgery with complete neurological recovery,Discussion and conclusion: Spinal TB in pregnancy causing neurological impairment is usually managed with urgent surgical interventions. This is one of the few reported cases where a conservative approach was undertaken, with close observation and a positive outcome.Therefore, it is important to carefully select patients needing surgical interventions and those who would benefit better from a conservative approach. High suspicion, early diagnosis, prompt treatment initiation and close monitoring are vital components in achieving the best outcome.

EFFICACY OF NERVE ROOT BLOCK FOR THE TREATMENT OF LUMBAR SPINAL CANAL STENOSIS IN ADULTS OLDER THAN 80 YRS OF AGE

Background: Patients with advanced lumbar spinal canal stenosis (LCS) often prefer non-operative treatment owing to decreased physiological function and comorbidities. Although the therapeutic value ofselective nerve root block (SNRB) for LCS is confirmed, there are few reports of its effectiveness in theelderly. We investigated the efficacy of SNRB for LCS in patients over 80 years of age. Methods: The subjects were 112 patients aged over 80 years (mean age: 84 years 45 men and 67 women)with medication-resistant LCS without cauda equina syndrome who underwent SNRB. Cases with acute-onset lumbar disc herniation were excluded. We retrospectively investigated and compared the presence orabsence of surgery, effect of SNRB, number of procedures, duration of disease, and magnetic resonanceimaging findings. Patients who could avoid the surgery by SNRB were defined as the effective group. Patientswhose symptoms were not relieved by SNRB and who underwent surgery and those whose symptoms werenot relieved but who continued conservative treatment were defined as the ineffective group. A total of oneto seven SNRBs were performed in both groups, and the same spine surgeon performed the entire procedurefrom SNRB to surgery. Results: There were 86 nonoperative patients (69 effective cases) and 26 operative patients the overall rateof effectiveness was 61% (69/112 patients). The area of the spinal canal at the responsible level was 108.63mm2in the effective group compared with 77.06 mm 2 in the ineffective group. This was significantlynarrower in the ineffective group (p=0.0094). There was no significant difference in the duration of illness,number of blocks, or hernia complication rate between the groups. No patient experienced severe neuralgiathat may have been caused by neuropathy during SNRB. Discussion: Our outcome showed that more than 60% of older patients with LCS showed symptomatic improvement with SNRB. SNRB can be performed relatively safely in the elderly and appears to be afavourable treatment option for older patients with various risks, such as poor general condition. Conclusions: Multiple sessions of SNRB may provide older patients with symptomaticimprovement and maybe an option for treatment.

Canadian Association of Radiologists Spine Imaging Referral Guideline.

The Canadian Association of Radiologists (CAR) Spine Expert Panel is made up of physicians from the disciplines of radiology, emergency medicine, neurology, neurosurgery, physiatry, a patient advisor, and an epidemiologist/guideline methodologist. After developing a list of 10 clinical/diagnostic scenarios, a rapid scoping review was undertaken to identify systematically produced referral guidelines that provide recommendations for one or more of these clinical/diagnostic scenarios. Recommendations from 23 guidelines and contextualization criteria in the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) for guidelines framework were used to develop 22 recommendation statements across the 8 scenarios (one scenario points to the CAR Trauma Referral Guideline and one scenario points to the CAR Musculoskeletal Guideline). This guideline presents the methods of development and the referral recommendations for myelopathy, suspected spinal infection, possible atlanto-axial instability (non-traumatic), axial pain (non-traumatic), radicular pain (non-traumatic), cauda equina syndrome, suspected spinal tumour, and suspected compression fracture. Spondyloarthropathies and spine trauma point to other CAR Diagnostic Imaging Referral Guidelines, Musculoskeletal and Trauma, respectively.

Health care disparities in complication and mortality rates following surgical management of cauda equina syndrome in New York State

Context While healthcare disparities related to race and ethnicity are well reported for non-emergent conditions, the literature on disparities in outcomes of emergent spinal conditions such as cauda equina syndrome (CES) remains sparse. Objective To evaluate racial disparities in complication, mortality, and readmission rates following surgical intervention for CES. Methods This retrospective analysis of The Statewide Planning and Research Cooperative System (SPARCS) database demonstrates that among patients surgically treated for CES in New York between 2015 and 2020. Bivariate and multivariate logistic regression analysis was performed to analyze the association of race and outcome variables after controlling for age, sex, comorbidities, length of stay, insurance, and hospital characteristics. Results Overall, 2,114 patients who underwent lumbar surgery for CES were identified. The study population was comprised of Black patients (177, 8%), White patients (79%, 1680), and Asian patients (257, 12%). Options for surgery included lumbar decompression (821, 38.8%), fusion (746, 35.3%), or both (547, 25.9%). On multivariate analysis, the odds of 30-day mortality were 2.98-fold greater in Black patients than in other patients (P = 0.029). By 180 and 360 days, the odds of mortality were 4.27 and 3.05-fold greater in Black patients than in other patients, respectively (P < 0.001 each). Thirty-day readmissions were 1.87-fold greater in Black patients than others (P = 0.004). No difference in overall complication rate was found between Black patients and all other race groups (P = 0.306). Conclusions Black patients surgically treated for CES face significantly higher rates of mortality and readmission than their non-Black counterparts.

Comparison of capsule and posterior lumbar interbody fusion in cauda equina syndrome with retention: a 24-month follow-up study

Background and objectivesCauda equina syndrome with retention (CESR) is a severe lumbar condition characterized by painless urine retention due to cauda equina nerve injury. The standard treatment, posterior lumbar interbody fusion (PLIF), often yields suboptimal results. This study aims to compare the clinical safety and efficacy of a novel technique, capsule lumbar interbody fusion (CLIF), with PLIF in CESR patients, hypothesizing that CLIF can enhance neurological recovery by reducing nerve tension.MethodsA single-center, retrospective study was conducted on 83 patients with CESR due to lumbar disc herniation, who underwent either PLIF (n = 44) or CLIF (n = 39). Patients were assessed preoperatively and at 3, 12, and 24 months postoperatively using the Oswestry Disability Index (ODI), Visual Analogue Scale (VAS), International Consultation on Incontinence Questionnaire Short Form (ICI-Q-SF), and Rintala score. Urodynamic studies and nerve tension measurements were also performed. Statistical analysis included t tests, Mann–Whitney U tests, and Spearman’s correlation.ResultsBoth groups showed significant postoperative improvements, but the CLIF group had superior outcomes. At 12 months, the CLIF group had lower VAS scores (1.15 ± 0.84 vs. 1.68 ± 0.60, p = 0.001) and ODI scores (23.31 ± 7.51 vs. 28.30 ± 8.26, p = 0.005). At 24 months, the CLIF group continued to show better results with ODI scores (15.97 ± 6.43 vs. 22.11 ± 6.41, p < 0.001) and higher ODI recovery rates (60.41 ± 17.6% vs. 44.71 ± 18.99%, p < 0.001). The CLIF group also had better ICI-Q-SF scores (2.13 ± 1.23 vs. 3.02 ± 1.45, p = 0.004) and Rintala scores (17.97 ± 1.43 vs. 16.59 ± 1.54, p < 0.001). Lower postoperative nerve tension in the CLIF group correlated with these improved outcomes.ConclusionsCLIF demonstrated superior efficacy over PLIF in treating CESR, with significant improvements in pain relief, functional recovery, and bladder and bowel function. This study highlights the potential of CLIF as a more effective surgical option for CESR, emphasizing its importance in improving patient outcomes and reducing the burden of CESR on patients and society.

Low back pain can be markedly increased after cauda equina syndrome: review of 50 medicolegal cases

Low back pain can be markedly increased after cauda equina syndrome: review of 50 medicolegal cases

Gender-related epidemiological characteristics of cauda equina syndrome caused by disc herniation: a 10-year study in Zenica-Doboj Canton, Bosnia and Herzegovina

Introduction: The unrecognized cases of cauda equina syndrome (CES) and the lack of epidemiological data in Bosnia and Herzegovina about this neurosurgical emergency, including the Zenica-Doboj Canton, contribute to the lack of awareness among health-care professionals, potentially leading to delayed diagnosis and referral for surgical decompression. Aim of this study is to analyze gender-related epidemiological characteristics of CES in Zenica-Doboj Canton in 10 years period. Methods: The study was conducted in the Zenica-Doboj Canton, and data were obtained from the time period between 2012 and 2022. The study included a total sample of 1709 patients diagnosed with disc herniation who underwent surgical decompression. In total, 48 patients developed CES. Results: The analysis unveiled noteworthy gender disparities, with male predominance (79.2% vs. 20.8%, p &lt; 0.001) and varying employment distributions (males: 23.7% unemployed, 63.2% employed, 13.1% retired; females: 40.0% unemployed, 20.0% employed, 40.0% retired, p &lt; 0.001). The calculated OR for 2012-2022 was 2.969 (95% CI: 1.576-5.593), signifying a substantial gender-incidence relationship for CES. CES-I incidence ranged 0.80–1.60/100,000 and CES-R ranged 0.25-0.83/100,000. Highest CES incidence was 4.17/100,000 (2015); the lowest was in 2019 with no CES-R cases reported. Male incidence peaked at 2.64/100,000 (2018), and the lowest was 1.06/100,000 (2013, 2017). For females, the highest was 1.17/100,000 (2018, 2021), with no cases reported in certain years. The affected level demonstrated gender differences, with L4/L5 prevalence in males (47.4%) and L3/L4 in females (50%, p = 0.165). Conclusion: This study revealed a higher incidence of CES in males compared to females in the Zenica-Doboj Canton. The heterogenicity of data regarding CES occurring due to the lumbar disc herniation is significant. This indicates a clear need for additional research and epidemiological studies that would highlight the population of patients that have a higher risk of CES onset.

Can clinical presentation predict radiologically confirmed cauda equina syndrome: retrospective case review of 530 cases at a tertiary emergency department

PurposeCauda equina syndrome (CES) may have significant individual consequences if diagnostic delays occur. Our aim was to evaluate the presenting subjective and objective features of patients with suspected CES in comparison to those with radiologically confirmed cauda equina compression (CEC)..MethodsThis was a retrospective analysis of all cases presenting with suspected CES to a tertiary emergency care unit over a two-year period. CEC was defined as radiological confirmation of CEC by Consultant Musculoskeletal (MSK) Radiologist report (MSK-CEC) and by measured canal occupancy due to an acute disc extrusion (> 75%)[measured by a Senior Spinal Surgeon (SP-CEC)]. Routine data collection was compared between categories. Chi square, multivariate regression analyses and ROC analysis of multiple predictors was performed.Results530 patients were included in this analysis, 60 (11.3%) had MSK-CEC, and 470 had NO- CEC. Only 43/60 (71.7%) had emergent surgery. Those with MSK-CEC and SP-CEC were statistically more likely to present with bilateral leg pain [(MSK-CEC OR 2.6, 95%CI 1.2, 5.8; p = 0.02)(SP-CEC OR 4.7, 95%CI 1.7, 12.8; p = 0.003)]; and absent bilateral ankle reflexes [(MSK-CEC OR 4.3; 95% CI 2.0, 9.6; p < 0.001)(SP CEC OR 2.5; 95%CI 1.0, 6.19; p = 0.05)] on multivariate analysis. The ROC curve analysis acceptable diagnostic utility of having SP-CEC when both are present [Area under the curve 0.72 (95%CI 0.61, 0.83); p < 0.0001].ConclusionThis study suggests that in those presenting with CES symptoms, the presence of both bilateral leg pain and absent ankle reflexes pose an acceptable diagnostic tool to predict a large acute disc herniation on MRI scan..

BENEFÍCIOS DO PILATES NA DOR LOMAR.

Low back pain, also called as lumbago, often causes functional disability. It is estimated that 80 to 84% of the world´s population will, suffer an episode of low back pain at some point in their lives. It can be related to pathologies such as infection, tumor, arthritis, fracture, cauda equina syndrome, disc herniation, and lifestyle factors; smoking, diet, sedentary lifestyle, and occupation; heavy physical work, repetitive movements. Pilates is an important treatment option for people with low back pain. Created by Joseph Humbertus Pilates, Pilates is a physical exercise method that makes it possible to condition the body and mind, correct muscle imbalances, improve posture, and tone the body. The objective of this work is to evaluate the effectiveness of the Pilates method in people with low back pain. This is a literature review based on the database pedro.org.au, which offers a specialized approach to physiotherapy research. The included studies cover, individuals aged 18 and over, ensuring the sample is composed of adults; all genders were considered in the study selection, ensuring representativity and inclusion of diverse populations.

Post-Operative Spondylodiscitis in a Patient at Mohammed VI University Hospital/Marrakech (Morocco)

Post-operative infections complicate 1 to 10% of spine surgeries and frequently cause disabling chronic painful after-effects. This is the leading cause of re-operation in the first month post-operatively. This is a 47-year-old female patient who underwent spinal surgery and then became superinfected, presenting for back pain in a febrile and general conservation context in whom the clinical examination noted cauda equina syndrome. The paraclinical assessment allowed us to isolate the staphylococcus aureus and an imaging study concluded to post-operative spondylodiscitis. Faced with this picture, an emergency surgical indication was made and the postoperative outcomes were satisfactory. In short, cauda equina syndrome remains a surgical emergency.

Spinal Dural Ectasia Spectrum: Management of Two Cases and Systematic Review of the Therapeutic Options.

To describe 2 cases with pathologic expansion of lumbosacral dura mater exerting compression on lumbosacral nerves treated with placement of lumboperitoneal shunt (LPS). Although dural ectasia (DE) is asymptomatic in most cases, a systematic review of the literature was performed focusing on the management when it causes symptoms. Pubmed/Medline and Embase databases were searched for the surgical management of DE. Both pediatric and adult patients were included. The presence of a cerebrospinal fluid leak was considered an exclusion criterion. An additional search was performed to provide a more complete picture of the DE spectrum considering meningoceles as a severe form of dural expansion. Differentiating DE from meningocele, only 20 patients were treated for symptomatic DE. Surgical management varied according to presentation and etiopathogenesis: blood patch or fibrin glue were attempted in case of intracranial hypotension, followed eventually by LPS or marsupialization or dura reduction in cases of failure, whereas LPS or spinal decompression were proposed in cases of radiculopathy or cauda equina syndrome. DE is a rare condition mostly associated with connective tissue disorders. The different etiopathogenesis may explain how it causes symptoms in specific conditions. Treatments should be chosen according to this and may be proposed at the appearance of symptoms since dural expansion is a self-sustained mechanism.

What Degree of Radiological Compression Predicts Cauda Equina Syndrome: A Retrospective Study at a National Tertiary Center

ObjectiveCauda Equina Syndrome (CES) is diagnosed both clinically and radiologically. However, it's unclear if a specific degree of cauda equina compression (CEC) on imaging can confirm the diagnosis. This study aimed to identify an optimal percentage of prolapse to canal ratio (PCR) on MRI that correlates with CEC, facilitating reliable decision-making for CES symptoms. MethodsA single-center retrospective case series analysis was conducted from 2020 to 2021. Sixty-one patients who underwent emergency lumbar discectomy within 48 hours of presentation were included, divided into a CES group and a disc prolapse (DP) group. CES cases were identified using ICD-10 code G83.4. PCR was calculated by dividing the width of the disc herniation by the total width of the spinal canal at the level of the herniation on single mid-sagittal T2 MRI scans, using the IC Measure software on Windows. ResultsCES most frequently occurred at the L4/5 level (37/61). The median PCR in CES cases was 76.19% (66.67 – 85.71), significantly higher than in DP cases, 48.08% (31.33 – 55.56) (p<0.001). A PCR threshold of 40% maximized sensitivity at 100% but had a specificity of 45%. Conversely, a threshold of 75% maximized specificity at 100% with a sensitivity of 50%. The optimal PCR, determined by the Youden index, was 66%, yielding a sensitivity of 75% and specificity of 97%, with an area under the curve (AUC) of 0.923. ConclusionsSimple radiological measurements of PCR can potentially triage CES patients and guide their management. Future studies should correlate PCR with clinical signs and symptoms for a comprehensive assessment.

Urgent MRI: when, what, and why—a single Italian center experience

PurposeThe aim of our study is to provide a list of clinical situations that might justify the performance of an urgent MRI (uMRI) based on clinical relevance, correlating the MRI findings with the clinical indications and the urgent management of patients.MethodsWe reviewed all uMRI scans of brain (buMRI) and spine (suMRI) performed in our Department from August 2020 to February 2024. We analyzed the main clinical indications, the neuroradiological findings, and the relevance of these results in the therapeutic decisions.ResultsThe main indication for buMRI was the evaluation of ischemic stroke detected at preliminary CT scan followed by coma, status epilepticus, suspected acute inflammatory diseases, trauma, suspicious of infective diseases, and pre-surgical evaluation of cerebral tumors. The main findings were: ischemia, acute inflammatory conditions, post-traumatic and post-ictal alterations, venous thrombosis, infective diseases, and cerebral tumors. 65% of patients underwent an urgent therapeutic intervention. The main indications for suMRI were clinical suspicion of myelopathy and radiculopathy including cauda equina syndrome secondary to trauma, neoplasms, inflammatory and infective diseases, degenerative changes, surgery, and vascular diseases. The main findings were: post-traumatic, degenerative and neoplastic myelopathy or radiculopathy, inflammatory and infective changes of the spinal cord, post-surgical fluid collections, and vascular diseases. About 77% of suMRI was followed by an urgent surgery.ConclusionsOur study showed an overall good correlation between buMRI-suMRI findings and the clinical indications for the examinations. Also, uMRI affected the urgent management in a good percentage of patients, proving the significance of uMRI findings.

Patients returning to the emergency department with symptoms of cauda equina syndrome: do the symptoms differ with radiological cauda equina compression?

Background The guidance for clinicians on who requires further investigation when suspecting cauda equina syndrome has become clearer in England following the publication of the national recommendations. This does not have specific advice for those patients who have had recent imaging with no compression, returning to a healthcare provider with a change in symptoms. These cases can cause difficulty for clinicians with limited access to imaging who can often be reassured by previous imaging. Method This study presents a retrospective review of the case notes of 45 patients presenting on two occasions to the same Emergency Department who underwent magnetic resonance imaging due to the clinical diagnosis of cauda equina syndrome. Those with compression of the cauda equina on the second visit were compared to those without a compressive cause for their symptoms. Results Patients presenting with an increased number of clinical symptoms associated with cauda equina syndrome on their return visit were more likely to have compression of the cauda equina on imaging. Conclusion The small numbers in this study would suggest caution, however, if patients present with an increasing number of symptoms further imaging should be considered, even with previous reassuring scans.