Posters
Academic Level (Author 1)
Resident
Discipline/Specialty (Author 1)
Family and Community Medicine
Academic Level (Author 2)
Faculty
Discipline/Specialty (Author 2)
Family and Community Medicine
Academic Level (Author 3)
Faculty
Discipline/Specialty (Author 3)
Family and Community Medicine
Discipline Track
Patient Care
Abstract
Background Cauda equina syndrome is a rare but serious condition from compressing the roots of the cauda equina in the lower lumbar spinal canal that accompany one of the following: Bladder and/or bowel dysfunction, reduced sensation in the saddle area, sexual dysfunction with possible neurological deficit in the lower limb. MRI findings are needed for confirmation. If it is not diagnosed early and treated properly, there can be disastrous outcomes such as permanent dysfunction in bowel, bladder, and sexual functions. Commonly it presented acute symptoms, but it is possible in gradual onset like in this case.
Case presentation The patient is a 19-year-old homosexual male brought to ER by his partner due to intractable back pain with the inability to walk for 7 days. He was a high school soccer athlete and recently graduated. 2 years ago, Back pain and subjective weakness have been started after nearly every game. Still, his MRI only revealed a 3mm protrusion herniated disc on L4/5 at the time. End of his senior season 5 months ago, he felt a worsening weakness in his lower extremities. Eventually, he couldn’t play the last 2 games of the season. It mildly improved after rest. However, 2 months ago, he started to feel sensory changes around his anus and his ability to erection intermittently. He also recognized decreasing sensation of urge to urinate and defecate with sporadic fecal incontinence for 2 months. At the time he has been diagnosed with COVID-19 as well. Because he is an undocumented immigrant with no insurance, he can’t afford to seek medical attention, he controlled his pain with unknown medication from Mexico. He had multiple same-sex sexual partners in recent 3 years.
Neuroexamination was significant for decreased rectal tone, saddle anesthesia, 1/5 ankle dorsiflexion, 1/5 G. toe dorsiflexion, and 2/5 Ankle plantar flexion on both, There is no Babinski reflex, no patellar reflex, no ankle reflex, and no bulbocavernosus reflex. Hip and knee joints are unable to be assessed due to severe lower back pain. No CVA tenderness, but lower abdominal distension is noted without tenderness. Pain, temperature, and two-point discrimination are significantly decreased under knee joint level bilaterally. Capillary refill was normal on both feet.
Laminectomy on L4, L5, and S1 with discectomy on L4/5, L5/S1 and bilateral foraminotomy on L4/5, L5/S1 was done for decompression. After surgery, back pain was alleviated to a tolerable range with NSAIDs. Physical therapy and occupation therapy for lower extremities and ambulation was initiated. His perineal sensation was getting better after surgery, and he could walk with a walker on POD3 and void himself without a catheter when discharged on POD5.
Conclusion It is important to educate young athletes with back pain about this condition and inform them to seek medical attention once the above symptoms develop.
Presentation Type
Poster
Recommended Citation
Yi, Changho; Perez, Evan; and Cano, Jose, "Gradual onset of paralysis in a soccer athlete: challenges in diagnosis in the patient with a socioeconomic condition" (2024). Research Colloquium. 39.
https://scholarworks.utrgv.edu/colloquium/2023/posters/39
Included in
Gradual onset of paralysis in a soccer athlete: challenges in diagnosis in the patient with a socioeconomic condition
Background Cauda equina syndrome is a rare but serious condition from compressing the roots of the cauda equina in the lower lumbar spinal canal that accompany one of the following: Bladder and/or bowel dysfunction, reduced sensation in the saddle area, sexual dysfunction with possible neurological deficit in the lower limb. MRI findings are needed for confirmation. If it is not diagnosed early and treated properly, there can be disastrous outcomes such as permanent dysfunction in bowel, bladder, and sexual functions. Commonly it presented acute symptoms, but it is possible in gradual onset like in this case.
Case presentation The patient is a 19-year-old homosexual male brought to ER by his partner due to intractable back pain with the inability to walk for 7 days. He was a high school soccer athlete and recently graduated. 2 years ago, Back pain and subjective weakness have been started after nearly every game. Still, his MRI only revealed a 3mm protrusion herniated disc on L4/5 at the time. End of his senior season 5 months ago, he felt a worsening weakness in his lower extremities. Eventually, he couldn’t play the last 2 games of the season. It mildly improved after rest. However, 2 months ago, he started to feel sensory changes around his anus and his ability to erection intermittently. He also recognized decreasing sensation of urge to urinate and defecate with sporadic fecal incontinence for 2 months. At the time he has been diagnosed with COVID-19 as well. Because he is an undocumented immigrant with no insurance, he can’t afford to seek medical attention, he controlled his pain with unknown medication from Mexico. He had multiple same-sex sexual partners in recent 3 years.
Neuroexamination was significant for decreased rectal tone, saddle anesthesia, 1/5 ankle dorsiflexion, 1/5 G. toe dorsiflexion, and 2/5 Ankle plantar flexion on both, There is no Babinski reflex, no patellar reflex, no ankle reflex, and no bulbocavernosus reflex. Hip and knee joints are unable to be assessed due to severe lower back pain. No CVA tenderness, but lower abdominal distension is noted without tenderness. Pain, temperature, and two-point discrimination are significantly decreased under knee joint level bilaterally. Capillary refill was normal on both feet.
Laminectomy on L4, L5, and S1 with discectomy on L4/5, L5/S1 and bilateral foraminotomy on L4/5, L5/S1 was done for decompression. After surgery, back pain was alleviated to a tolerable range with NSAIDs. Physical therapy and occupation therapy for lower extremities and ambulation was initiated. His perineal sensation was getting better after surgery, and he could walk with a walker on POD3 and void himself without a catheter when discharged on POD5.
Conclusion It is important to educate young athletes with back pain about this condition and inform them to seek medical attention once the above symptoms develop.