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Question Date: 06/09/2023

Question: A 53-year-old man presents with flaccid paraparesis and sphincter dysfunction which developed gradually over 4 months. MRI imaging of the spinal cord and cauda equina is unremarkable. His past history is significant for hyperlipidemia, hypertension, and a history of testicular cancer treated with orchiectomy and radiation 14 years ago. Complete blood count and differential are normal. What is the most likely cause of his symptoms?

Options:

• Epidural abscess
• Herpes zoster myelitis
• Neuromyelitis optica
• Radiation injury

Correct Answer: Radiation injury

Explaination: Cauda equina syndrome and myelopathies may occur as a delayed injury after radiation therapy. This is most commonly seen following radiation for testicular seminoma or lymphoma and occurs at a mean interval of 15 years after the radiation exposure. The spine imaging for this patient did not show evidence of an epidural abscess or other source of compression or inflammation

Reference: Page 155,Tarulli AW. Disorders of the cauda equina. Continuum (Minneap Minn). 2015 Feb21(1 Spinal Cord Disorders)146-58. doi 10.121201.CON.0000461090.09736.45. PMID 25651223.