Differential diagnosis and treatment of acute cauda equina syndrome in the human immunodeficiency virus positive patient: A case report and review of the literature

被引：4

作者：

Panos G. ^{[1
,2
]}

Watson D.C. ^{[2
]}

Karydis I. ^{[1
]}

Velissaris D. ^{[3
]}

Andreou M. ^{[3
]}

Karamouzos V. ^{[3
]}

Sargianou M. ^{[2
]}

Masdrakis A. ^{[1
]}

Chra P. ^{[4
]}

Roussos L. ^{[5
]}

机构：

[1] Special Infections Unit, 2nd Internal Medicine Clinic, 1st I.K.A.Penteli General Hospital, Melissia, Athens

[2] Department of Infectious Diseases, Patras University General Hospital, Rion, Patras

[3] Internal Medicine Department, University Hospital of Patras, Rion, Patras

[4] Department of Microbiology, Benakio-Korgialenio Hospital, 1 Erythrou Staurou Street, Athens

[5] Neurosurgery Clinic, K.A.T. Hospital, 2 Nikis Street, Kifissia, Athens

来源：

Journal of Medical Case Reports | / 10卷 / 1期

关键词：

Cauda equina syndrome; CMV; HIV; Lumbar disk fragment; Mycobacterium tuberculosis; Myeloradiculopathy;

D O I：

10.1186/s13256-016-0902-y

中图分类号：

学科分类号：

摘要：

Background: Acute cauda equina syndrome is an uncommon but significant neurologic presentation due to a variety of underlying diseases. Anatomical compression of nerve roots, usually by a lumbar disk hernia is a common cause in the general population, while inflammatory, neoplastic, and ischemic causes have also been recognized. Among human immunodeficiency virus (HIV) infected patients with acquired immunodeficiency syndrome, infectious causes are encountered more frequently, the most prevalent of which are: cytomegalovirus, herpes simplex virus 1/2, varicella zoster virus, and Mycobacterium tuberculosis infections. Studies of cauda equina syndrome in well-controlled HIV infection are lacking. We describe such a case of cauda equina syndrome in a well-controlled HIV-infected patient, along with a brief review of the literature regarding the syndrome's diagnosis and treatment in individuals with HIV infection. Case presentation: A 36-year-old Greek male, HIV-positive patient presented with perineal and left hemiscrotal numbness, lumbar pain, left-sided sciatica, and urinary incontinence. Magnetic resonance imaging of the patient's lumbar spine revealed intrathecal migration of a fragment from an intervertebral lumbar disk exerting pressure on the cauda equina. A cerebrospinal fluid examination, brain computed tomography scan, spine magnetic resonance imaging, and serological test results were negative for central nervous system infections. Our patient underwent emergency neurosurgical spinal decompression, which resolved most symptoms, except for mild urinary incontinence. Conclusions: Noninfectious etiologies may also cause cauda equina syndrome in HIV-infected individuals, especially in well-controlled disease under antiretroviral therapy. Prompt recognition and treatment of the underlying cause is important to minimize residual symptoms. Targeted antimicrobial chemotherapy is used to treat infectious causes, while prompt surgical decompression is favored for anatomical causes of cauda equina syndrome in the HIV-infected patient. © 2016 Panos et al.

引用

共 49 条

[1]

Orendacova J., Cizcova D., Kafka J., Lukacova N., Marsala M., Sulla I., Et al., Cauda equina syndrome, Prog Neurobiol, 64, 6, pp. 613-637, (2001)

[2]

Jacomet C., Lebrette M., El Amrani M., Monfort L., Gozlan J., Girard P., Et al., Lesions of the conus medullaris and the cauda equina caused by cytomegalovirus in HIV infection. 7 cases, Presse Med, 24, 11, pp. 527-530, (1995)

[3]

Cohen B., McArthur J., Grohman S., Patterson B., Glass J., Neurologic prognosis of cytomegalovirus polyradiculopathy in AIDS, Neurology, 43, 3 PT 1, pp. 493-499, (1993)

[4]

Corral I., Quereda C., Casado J., Cobo J., Navas E., Perez-Elias M., Et al., Acute polyradiculopathies in HIV-infected patients, J Neurol, 244, 8, pp. 499-504, (1997)

[5]

Candy S., Chang G., Andronikou S., Acute myelopathy or cauda equina syndrome in HIV-positive adults in a tuberculosis endemic setting: MRI, clinical, and pathologic findings, AJNR Am J Neuroradiol, 35, 8, pp. 1634-1641, (2014)

[6]

Hussain S., Gullan R., Chitnavis B., Cauda equina syndrome: Outcome and implications for management, Br J Neurosurg, 17, 2, pp. 164-167, (2003)

[7]

Tatli M., Guzel A., Ceviz A., Karadag O., Posterior epidural migration of sequestered lumbar disc fragment causing cauda equina syndrome, Br J Neurosurg, 19, 3, pp. 257-259, (2005)

[8]

Ma B., Wu H., Jia L.S., Yuan W., Shi G.D., Shi J.G., Cauda equina syndrome: A review of clinical progress, Chin Med J, 122, 10, pp. 1214-1222, (2009)

[9]

Saint-Louis L.A., Lumbar spinal stenosis assessment with computed tomography, magnetic resonance imaging, and myelography, Clin Orthop Relat Res., 384, pp. 122-136, (2001)

[10]

Dosoglu M., Is M., Gezen F., Ziyal M., Posterior epidural migration of a lumbar disc fragment causing cauda equina syndrome: Case report and review of the relevant literature, Eur Spine J, 10, 4, pp. 348-351, (2001)

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