Acute Cauda Equina Compression Revealing Hodgkin’s Disease

STUDY DESIGN This is a case report of a young patient who experienced an acute epidural compression of cauda equina revealing Stage IV Hodgkin's disease. OBJECTIVES To draw attention to this rare presentation of Hodgkin's disease, and to assess the role of surgery in acute cauda equina compression in a context of a chemosensitive disease. SUMMARY OF BACKGROUND DATA Lymphomatous tissue in Hodgkin's disease may involve the spine usually in the setting of advanced disease. Initial manifestation of Hodgkin's disease in the spine is rare. The management of this rare presentation may be conservative, but surgery provides the most rapid way of neurologic tissue decompression. METHODS The case of a 14-year-old patient who experienced an acute epidural compression of cauda equina revealing Stage IV Hodgkin's disease is presented. RESULTS The patient complained of an increased lower back pain of 1-month duration before he developed lower limbs numbness, loss of perineal sensation, and urinary retention. Sagittal and axial T2-weighted magnetic resonance images of the lumbar spine revealed tumoral invasion of the epidural space compressing the cauda equina. Emergency surgical decompression was performed. In fine, Stage IV Hodgkin's disease revealed by acute epidural cauda equina compression was diagnosed. The patient recovered normal neurologic functions in a few days and then underwent chemotherapy and radiotherapy. CONCLUSION Although a rare situation, Hodgkin's disease may involve the spinal epidural space at presentation. The management is complex, but surgery provides the most rapid means of diagnosis and neurologic tissue decompression in severely affected patients.