Scan-Negative Cauda Equina Syndrome: A Prospective Cohort Study.

Area of Science:

• Neurosurgery
• Neurology
• Functional Neurologic Disorders

Background:

• Cauda Equina Syndrome (CES) is a critical condition requiring prompt diagnosis and management.
• Scan-negative CES, lacking clear structural abnormalities on imaging, presents diagnostic challenges.
• Understanding the etiology and clinical features of scan-negative CES is crucial for effective patient care.

Purpose of the Study:

• To delineate the clinical characteristics associated with diagnosis, mechanism, and etiology in patients experiencing scan-negative CES.
• To differentiate scan-negative CES from scan-positive CES and other neurological conditions.

Main Methods:

• A prospective study involving consecutive patients presenting with CES clinical features at a neurosurgery center.
• Data collection included semi-structured interviews and questionnaires covering symptoms, neurological examination, comorbidities, and functional outcomes.
• Patients were categorized into scan-positive CES, nerve root compression without CES, and scan-negative CES groups.

Main Results:

• Scan-negative CES patients (n=61) were younger (mean age 40) and more frequently female (77%) compared to scan-positive CES (n=47).
• A higher prevalence of functional neurologic disorder signs (68%), reporting worst-ever back pain (70%), and panic attack symptoms (70%) was observed in scan-negative CES.
• Reduced bilateral ankle jerks were significantly more common in scan-positive CES (78%) than scan-negative CES (12%).

Conclusions:

• This study supports a model where functional neurologic disorders, acute pain, and medication may play significant roles in scan-negative CES.
• The findings emphasize the need for a comprehensive diagnostic approach considering both organic and functional components in CES.
• Further research into the interplay of these factors is warranted to refine treatment strategies for scan-negative CES.