Abu Hasan, Muhammad Abdus-Syakur and Hassan, Muhammad Afiq (2025) Cauda Equina Syndrome secondary to sacral chordoma: a case report. In: Tripartite Congress 2025, 58th Malaysia-Singapore Congress of Medicine, 5th AMM-AMS-HKAM Tripartite congress of Medicine, 7th Emergency Medicine Annual Symposium (EMAS) Embracing Evidence, Envisioning Eminence, Shangri-La hotel Kuala Lumpur.
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Abstract
Introduction: Cauda equina syndrome (CES) is a rare yet urgent neurosurgical condition characterized by the compression of cauda equina nerve roots, leading to potentially irreversible neurological deficits if untreated. While lumbar disc herniation is the most common cause, rare entities like sacral chordoma can also result in CES. Sacral chordomas are malignant tumors originating from notochord remnants, often presenting with vague symptoms that delay diagnosis. This case report highlights an atypical presentation of CES secondary to sacral chordoma, emphasizing the importance of early recognition, imaging, and surgical intervention. Case Description: A 63-year-old Malay gentleman with diabetes, hypertension, and dyslipidemia presented with acute onset urinary and bowel incontinence, following a month of buttock pain and lower urinary tract symptoms. He initially sought treatment for worsening buttock pain and was diagnosed with coccydynia. He was subsequently admitted to the urology ward for acute urinary retention secondary to benign prostatic hyperplasia and was discharged with clean intermittent selfcatheterization. However, the next day, he developed acute urinary and bowel incontinence, prompting a second visit to the emergency department. Neurological examination revealed saddle anesthesia and reduced sensation at S3-S5 levels, with absent perianal reflexes. MRI revealed an expansile lesion from S2-S4, suggestive of chordoma. Histopathological examination confirmed the diagnosis. The patient underwent wide sacral resection up to S1 with posterior spinal instrumentation and fusion. Discussion: This case underscores the diagnostic challenge posed by CES with atypical presentations. The absence of classic lower limb symptoms delayed recognition, ighlighting the importance of thorough history-taking and detailed neurological examinations. Sacral chordomas, although rare, must be considered in patients with unexplained urinary or bowel dysfunction. MRI is pivotal in confirming diagnosis and guiding management. Early surgical intervention is critical to prevent permanent neurological deficits. Conclusion: Clinicians should maintain a high index of suspicion for CES, especially in atypical presentations. Recognizing rare causes like sacral chordoma is essential to ensure timely diagnosis and intervention, thereby improving patient outcomes.
| Item Type: | Proceeding Paper (Poster) |
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| Uncontrolled Keywords: | Cauda equina syndrome, sacral chordoma, saddle anaesthesia, incontinence |
| Subjects: | R Medicine > R Medicine (General) R Medicine > RD Surgery > RD701 Orthopedics R Medicine > RD Surgery > RD93 Emergency Surgery. Wounds and Injuries |
| Kulliyyahs/Centres/Divisions/Institutes (Can select more than one option. Press CONTROL button): | Kulliyyah of Medicine > Department of Emergency Medicine Sultan Ahmad Shah Medical Centre (SASMEC) |
| Depositing User: | Dr. Muhammad Abdus-Syakur Abu Hasan |
| Date Deposited: | 02 Sep 2025 09:11 |
| Last Modified: | 02 Sep 2025 09:11 |
| URI: | http://irep.iium.edu.my/id/eprint/123000 |
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