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ANKI Neuro > [17] Cauda Equina Syndrome > Flashcards

[17] Cauda Equina Syndrome Flashcards

1
Q

What is cauda equina syndrome?

A

A condition that occurs when the bundle of nerves below the end of the spinal cord is damaged

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2
Q

What is the cauda equina?

A

A bundle of nerves below the conus medullaris

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3
Q

Where does the cauda equina branch from?

A

The lower end of the spinal cord

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4
Q

What nerve roots does the cauda equina contain?

A
  • L1-L5

- S1-S5

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5
Q

What do the nerve roots from L4 to S3 join to form?

A

The sciatic nerve

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6
Q

Where do the nerve roots combine to form the sciatic nerve?

A

The sacral plexus

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7
Q

Where does the sciatic nerve travel?

A

Towards the feet (caudally)

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8
Q

How does cauda equina syndrome arise?

A

Compression, trauma or other damage to the spinal canal that contains the cauda equina

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9
Q

What are the potential cause of cauda equina syndrome?

A
  • Herniation of a lumbar disc
  • Tumours
  • Trauma
  • Infection
  • Epidural abscess
  • Congenital defects
  • Spondylolisthesis
  • Late-stage ankylosing spondylitis
  • Post-operative haematoma
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10
Q

Herniated discs at what levels most commonly cause cauda equina syndrome?

A
  • L4/5

- L5/S1

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11
Q

What tumours can cause cauda equina syndrome?

A
  • Metastases
  • Lymphoma
  • Spinal tumours
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12
Q

What congenital defects can cause cauda equina syndrome?

A
  • Congenital spinal stenosis
  • Kyphoscoliosis
  • Spina bifida
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13
Q

What are the risk factors for disc herniation?

A
  • Male
  • Heavy lifting
  • Middle age
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14
Q

What is the period of onset for most cases of cauda equina syndrome?

A

Suddent onset with rapid progression within hours to days

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15
Q

How can cauda equina syndrome rarely present?

A

With a slowly evolving painless onset

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16
Q

Do all patients have a complete cauda equina syndrome?

A

No, 30-50% have a partial syndrome

17
Q

What are the symptoms of cauda equina syndrome?

A
  • Low back pain
  • Pain in legs
  • Uni-/bi-lateral lower limb sensory deficit
  • Uni-/bi-lateral lower limb motor deficit
  • Bowel and/or bladder dysfunction
  • Saddle and perianal anaesthesia
  • Sexual dysfunction
18
Q

What urinary dysfunctions may occur in cauda equina syndrome?

A
  • Retention
  • Difficulty starting or stopping stream
  • Overflow incontinence
  • Decreased bladder or urethral sensation
19
Q

What bowle dysfunctions may occur in cauda equina syndrome?

A
  • Faecal incontinence
  • Constipation
  • Loss of anal tone and sensation on rectal examination
20
Q

How is cauda equina syndrome typically diagnosed?

A

Clinical diagnosis

21
Q

What can assist the clinical diagnosis of cauda equina syndrome?

A

Radiological imaging

22
Q

What is the preferred imaging modality for confirming a diagnosis of cauda equina syndrome?

A

MRI

23
Q

What can MRI also show in cauda equina syndrome?

A

The level of compression and underlying cause

24
Q

When can suspected cauda equina syndrome be ruled out?

A

Only if refuted by MRI

25
Q

What other imaging modalities can be used in the investigation of cauda equina syndrome?

A

Myelography and CT scan

26
Q

What are further investigations of cauda equina syndrome concerned with?

A

Localising the site of compression and the underlying cause

27
Q

What are the potential differentials for cauda equina syndrome?

A
  • Conus medullaris syndrome
  • Mechanical back pain
  • Prolapsed lumbar disc
  • Fracture of lumbar vertebrae
  • Spinal tumour
  • Spinal cord compression
  • Peripheral neuropathy
28
Q

What is conus medullaris syndrome?

A

Similar to cauda equina syndrome but with less prominent nerve root pain and mainly urinary retention and constipation problems

29
Q

What should be done once cauda equina syndrome is suspected?

A

Immediate referral for neurosurgical consultation

30
Q

What is indicated in most patients with cauda equina syndrome?

A

Urgent spinal decompression

31
Q

Why is urgent spinal decompression often indicated in cauda equina syndrome?

A

To prevent permanent neurological damage

32
Q

What can be given in cauda equina syndrome due to malignant disease to relieve cord compression if surgery is not an option?

A

Radiotherapy

33
Q

What do other treatment options in cauda equina syndrome depend on?

A

The underlying cause

34
Q

What treatment options may be useful in patients with cauda equina syndrome and an underlying inflammatory cause?

A

Anti-inflammatory agents including steroids

35
Q

What is an example of an inflammatory cause of cauda equina syndrome?

A

Ankylosing spondylitis

36
Q

What should infectious causes of cauda equina syndrome be treated with?

A

Appropriate antibiotics

37
Q

What should patients with spinal neoplasms causing cauda equina syndrome be evaluated for?

A

Chemotherapy and radiotherapy

38
Q

What post-operative care is needed in cauda equina syndrome?

A
  • Addressing lifestyle issues
  • Physiotherapy
  • Occupational therapy
39
Q

What are the potential complications of cauda equina syndrome?

A
  • Paralysis
  • Sensory abnormalities
  • Bladder, bowel and sexual dysfunction

ANKI Neuro (30 decks)

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