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Neurology (Expert Forum)
Multiple symptoms seem to indicare epidural compression syndrome
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Multiple symptoms seem to indicare epidural compression syndrome
by Mr. Doe, Apr 10, 2006 12:00AM
I had a spine injury in 1993. MRI shows multi level bulges with left paracentral focal protrusion at L4-5, stenosis present at L2-3, severe degen and broad based bulge with severe bilat foraminal narrowing at L5-S1. A faied discogram in 1997 caused punctures and CSF leakage for 9 days. In 1998 I suffered rapid urinary retention to full ret in one week and was admitted to an ER for cath. No cause determined but stopping Paxil seemed to partially help after 30 days and cath removed. Limited function since with urgency, low pressure, and low flow. Constipation (blamed on ms contin for low back) has gotten worse and worse to point of little sensation and 4-5 day cycle. Sexual dysfunction developed (loss of propulsion). Discogram in 2000 showed L5-S1 to be worst pain.In last 3-4 years very cold feet and spoon nails, plus Vitiligo developed. On 3-13-06 I began to have severe postural headaches,perianal pain, loss of anal sphincter tone,odd muscle twitching, worsening cold feet and severe back pain upon standing, relieved by laying down. Lumbar MRI (above) was taken in the ER on 3-17-06 with no reason for epidural compression found. Symptoms seem to be classic red flag warnings of a slow onset form of CES or CMS. Should an MRI contrast been used or a different test run in ER? Urine and bowel dysfunction have been worsening since 1997.Sex dysfunc intermittent until a year ago.What tests should be done to pin this all down? My doctors are baffled and I am in a panic knowing I may have cauda equina. ESR and Rheum panel look O.K.Pain in low back on hyperextension standing. Any ideas?
Doctor's Answer
by CCF-Neuro-M.D.-PW, Apr 13, 2006 12:00AM
I cannot give you a clinical diagnosis over the internet as this site is purely educational
Cauda equina syndrome is very rare, and is seen usually in the setting of a tumor or cancer. MRI is usually suffiecient to show whether there is spinal cord compression or not, as long as all the appropriate areas of the spine are visualized. Contrast may be helpful if deciding what is the cause of a mass if one is present, but is usually not done or required for routine rulout spinal cord compression studies.
Your symptoms could be consistent with a history of spinal cord injury - I cannot comment more specifically as I have no details of the severity of the injury. Various test such as needle EMG of the anal sphincter, urine flow tests, tests of erectile function, can measur ethe degree of injury and sometimes help localized the level of the injury along with the neurological examination.
Cauda equina syndrome is very rare, and is seen usually in the setting of a tumor or cancer. MRI is usually suffiecient to show whether there is spinal cord compression or not, as long as all the appropriate areas of the spine are visualized. Contrast may be helpful if deciding what is the cause of a mass if one is present, but is usually not done or required for routine rulout spinal cord compression studies.
Your symptoms could be consistent with a history of spinal cord injury - I cannot comment more specifically as I have no details of the severity of the injury. Various test such as needle EMG of the anal sphincter, urine flow tests, tests of erectile function, can measur ethe degree of injury and sometimes help localized the level of the injury along with the neurological examination.