Neurogenic intermittent claudication caused by vasculitis in the cauda equina: an autopsy case report.

Abstract

PURPOSE:

Intermittent claudication (IC) refers to leg pain that is induced by walking and relieved by rest. Neurogenic IC is usually associated with lumbar canal stenosis (LCS). We present rare findings from an autopsied patient who had neurogenic IC caused by vasculitis in the cauda equina.

METHODS:

We performed antemortem neurological and electrophysiological assessments, sural nerve biopsy, and post-mortem examination of the spinal cord and brain.

RESULTS:

A 61-year-old man noted sudden-onset leg pain that was not associated with any traumatic trigger. His leg pain consistently appeared when the patient walked and quickly faded on stopping. Spine surgery and cardiovascular departments both made a diagnosis of IC. However, magnetic resonance imaging (MRI) did not show LCS, and all ankle-brachial pressure indices were normal. He subsequently developed diffuse muscle weakness of the legs a month after disease onset. Myeloperoxidase antineutrophil cytoplasmic autoantibody was seropositive (140 IU/mL), and a sural nerve biopsy revealed axonal injury and angiitis. MRI showed multiple cerebral infarctions. He was diagnosed with microscopic polyangiitis (MPA) and underwent corticosteroid therapy. He died from complications two months after the onset. A post-mortem study revealed vasculitis in the subarachnoid space of the cauda equina, spinal cord, and brain parenchyma. The cauda equina showed a combined loss of small and large axonal fibres. The lumbar cord displayed central chromatolysis of the lower motor neurons.

CONCLUSION:

MPA is a rare cause of neurogenic IC when the symptom is acute and multimodal. Small-vessel vasculitis affecting the cauda equina may underlie MPA-associated IC.

• Authors: Takashi Ando, Hazuki Watanabe, Yuichi Riku, Mari Yoshida, Yoji Goto, Ryota Ando, Masahiko Fujino, Masafumi Ito, Haruki Koike, Masahisa Katsuno, Yasushi Iwasaki
• Journal: European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society (Eur Spine J) Vol. 32 Issue 7 Pg. 2602-2606 (Jul 2023) ISSN: 1432-0932 [Electronic] Germany
• PMID: 36416968 (Publication Type: Case Reports, Journal Article)
• Copyright: © 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

Topics

• Male
• Humans
• Middle Aged
• Cauda Equina (diagnostic imaging, pathology)
• Autopsy
• Leg
• Intermittent Claudication (diagnostic imaging, etiology)
• Spinal Stenosis (complications, diagnostic imaging)
• Constriction, Pathologic
• Pain (complications)
• Vasculitis (complications, diagnostic imaging, pathology)