title: Cauda equina syndrome: an uncommon symptom of aortic diseases.
abstract: BACKGROUND
  In order to help diagnose and deal with the fetal aortic diseases in time, we retrospectively reviewed 8 patients who presented with cauda equina syndrome (CES) but actually suffered from low spinal nerve ischemia due to aortic diseases.
  
  
  METHODS
  8 patients were initially diagnosed as CES. 7 patients were confirmed with aortic diseases. 1 patient was confirmed with aortic saddle embolism post emergent laminectomy. Relief of CES symptoms was evaluated during preoperation and follow-up period.
  
  
  RESULTS
  1 patient was diagnosed as aortic dissection and 5 patients as AAA. These 6 patients underwent endovascular aortic repair (EVAR). The CES was relieved in 5-10 d post procedure. The 7th patient was diagnosed with acute abdominal aortic occlusion and then underwent catheter directed thrombolysis with recombinant tissue plasminogen activator (rTPA) for 20 h and CES disappeared. The JOA scores of the 7 patients were recovered from preoperative 15.14±1.21 to 21.00±2.16 within 5-10 d (P<0.01), and evaluated to be 24.12±1.34, 25.88±1.21 and 26.29±1.11 at 3 m-, 6 m- and 12 m-follow-up point, respectively. The 8th patient was initially diagnosed as lumbar spinal stenosis and lumbar disc herniation. The patient underwent emergent vertebral canal decompression and presented with serious CES symptoms. CTA confirmed that the patient had been suffered from aortic saddle embolism (ASE).
  
  
  CONCLUSIONS
  CES caused by abdominal aortic diseases is a special event with fetal consequences if it is not recognized and treated promptly. Orthopedists and neurosurgeons should pay attentions particularly to this issue to preserve the cauda equina functions to their maximums.
authors.affiliation: Department of Interventional Therapy, Beijing Shijitan Hospital, Capital Medical University Beijing, China.
authors.forename: Fuliang
authors.initials: F
authors.lastname: He
authors.affiliation: Department of Vascular Surgery, Beijing Chaoyang Hospital, Capital Medical University Beijing, China.
authors.forename: Tong
authors.initials: T
authors.lastname: Xing
authors.affiliation: Department of Orthopedics, Beijing Shijitan Hospital, Capital Medical University Beijing, China.
authors.forename: Fang
authors.initials: F
authors.lastname: Yu
authors.affiliation: Department of Orthopedics, Beijing Shijitan Hospital, Capital Medical University Beijing, China.
authors.forename: Hongchuan
authors.initials: H
authors.lastname: Li
authors.affiliation: Department of Orthopedics, Beijing Shijitan Hospital, Capital Medical University Beijing, China.
authors.forename: Xiutong
authors.initials: X
authors.lastname: Fang
authors.affiliation: Department of Orthopedics, Beijing Shijitan Hospital, Capital Medical University Beijing, China.
authors.forename: Hongxing
authors.initials: H
authors.lastname: Song
keywords: Cauda equina syndrome; aortic diseases; misdiagnosis