Cauda equina syndrome secondary to portal vein thrombosis: case report of favorable outcome with conservative treatment
| Autor: | Gianluca Agresta, Fabio Pozzi, Davide Locatelli, Alberto Campione |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
Deep vein Cauda equina syndrome Inferior vena cava deep vein thrombosis 03 medical and health sciences 0302 clinical medicine cauda equina syndrome epidural varices portal vein thrombosis portocaval shunts sacral sciatica medicine Sciatica Epidural venous plexus business.industry General Medicine medicine.disease Thrombosis Portal vein thrombosis Surgery Pulmonary embolism medicine.anatomical_structure medicine.vein 030220 oncology & carcinogenesis medicine.symptom business 030217 neurology & neurosurgery |
| Popis: | Epidural varicosis is a rare though well-known cause of cauda equina syndrome (CES). Although inferior vena cava (IVC) obstruction is the most common finding in such cases, portal vein hypertension can lead to epidural venous plexus engorgement by means of lumbar portocaval shunt activation. A 40-year-old woman presented with right-sided sciatica, which progressed to right foot drop and a 3-day history of vesical tenesmus and fecal retention. She was initially diagnosed with L4–5 lumbar disc protrusion. However, contrast-enhanced lumbar MRI scan showed the presence of epidural varices in the L3–S1 tract. Given the absence of vascular anomalies amenable to resection, etiological conservative treatment was addressed. Therefore, a complete diagnostic workup was performed and revealed deep vein thrombosis (DVT), pulmonary embolism, and portal vein thrombosis. Oral anticoagulant therapy was initiated and prompt resolution of CES was observed. To the authors’ knowledge, this is the first report of CES secondary to epidural varicosis in the setting of acute portal vein thrombosis and extrahepatic portal vein obstruction (EHPVO). In cases of epidural varicosis, conservative etiological treatment is the most appropriate choice as CES may be the epiphenomenon of underlying systemic pathophysiological processes. |
| Databáze: | OpenAIRE |
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