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Inferior vena cava thrombosis causing acute cauda equina syndrome. Case report.

A Alex Mohit1, David J Fisher, Dana C Matthews

  • 1Department of Neurosurgery, University of Washington and Children's Hospital and Regional Medical Center, Seattle, Washington, USA. abmohit@u.washington.edu

Journal of Neurosurgery
|March 3, 2006
PubMed
Summary

Inferior vena cava (IVC) thrombosis can cause cauda equina syndrome, leading to back pain and leg weakness. Prompt IVC thrombectomy improved symptoms in a 16-year-old patient.

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Area of Science:

  • Neurology
  • Vascular Surgery
  • Radiology

Background:

  • Cauda equina syndrome (CES) is a rare neurological condition often caused by spinal stenosis or disc herniation.
  • Inferior vena cava (IVC) thrombosis, a condition involving blood clots in the large vein that carries deoxygenated blood from the lower and middle body into the liver into the heart, is typically associated with lower extremity swelling and pain.

Observation:

  • A 16-year-old female presented with acute low-back pain, bilateral leg pain and weakness, and paresthesias.
  • Magnetic resonance imaging (MRI) and MR venography revealed epidural venous plexus engorgement and mild cauda equina compression.
  • Pelvic and lower extremity venography demonstrated extensive thrombosis of the iliac veins, femoral veins, and the IVC.

Findings:

  • The patient underwent an IVC thrombectomy due to progressive neurological deficits.

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  • Post-operatively, the patient experienced rapid improvement in symptoms and returned to baseline function within one week.
  • Follow-up imaging confirmed resolution of venous engorgement and cauda equina decompression.

    • Implications:

    • This case highlights a rare but significant association between IVC thrombosis and CES.
    • Early recognition and intervention, including thrombectomy, may be crucial for managing CES secondary to IVC thrombosis.
    • Further research is warranted to elucidate the pathophysiology and optimal management strategies for this condition.