| 제목 |
Unilateral cauda equina syndrome due to cancer metastasis diagnosed with electromyography: A case |
| 소속 |
Kyungpook National University Hospital, Department of Rehabilitation Medicine1, Kyungpook National University Chilgok Hospital, Department of Rehabilitation Medicine2 |
| 저자 |
Chan-Hee Park1*, Tae-Du Jung2†, Jae-Eun Lee2, Seung-Hwan Jung1, Hyun-Woo Jung2, Seong-Hun Kim1, Yang-Soo Lee1 |
Background: Typical cauda equina syndrome (CES) presents low back pain, bilateral leg pain with motor and sensory deficits, genitourinary dysfunction, saddle anaesthesia and fecal incontinence. And it is neurosurgical emergencies, which is essential to diagnose as soon as possible, and need prompt intervention. However, unilateral CES are rare. We here report a unique case of a patient who had unilateral symptoms of CES due to cancer metastasis and diagnosed with electromyography.
Case presentation: A 71-year-old man with diffuse large B cell lymphoma (DLBCL) suffered from severe pain, motor weakness on the right lower limb and urinary incontinence, hemi-saddle anesthesia. It was easy to be confused with lumbar radiculopathy due to unilateral symptom. Lumbar spine magnetic resonance image (MRI) showed suspected multifocal bone metastasis in TL spine including T11-L5 and bilateral sacrum, iliac bones and suspected epidural metastasis at L4/5, L5/S1 and sacrum. PET CT conducted after the 3rd R-CHOP showed residual hypermetabolic lesions in L5, sacrum, and right presacral area. Nerve conduction studies (NCS) revealed peripheral neuropathy on both hands and feet. Electromyography (EMG) presented abnormal results indicating development of muscle membrane instability following neural injury not only right symptomatic side, but also the other side which is considered intact.. Overall he was diagnosed with cauda equina syndrome caused by DLBCL metastasis and referred to neurosurgical department.
Conclusion: Early diagnosis of unilateral CES may be unnoticed due to its unilateral symptoms. Failure to perform the intervention at proper time can impede recovery and leaves a permanent complications. Therefore, physicians need to know not only the typical CES, but also the clinical features of atypical CES when encountering a patient, and further evaluation such as electrodiagnostic study or lumbar spine MRI have to be considered.
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Table 1. Motor and Sensory Nerve Conduction Study
Table 2. Needle Electromyography Study
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