[17] Cauda Equina Syndrome Flashcards
What is cauda equina syndrome?
A condition that occurs when the bundle of nerves below the end of the spinal cord is damaged
What is the cauda equina?
A bundle of nerves below the conus medullaris
Where does the cauda equina branch from?
The lower end of the spinal cord
What nerve roots does the cauda equina contain?
- L1-L5
- S1-S5
What do the nerve roots from L4 to S3 join to form?
The sciatic nerve
Where do the nerve roots combine to form the sciatic nerve?
The sacral plexus
Where does the sciatic nerve travel?
Towards the feet (caudally)
How does cauda equina syndrome arise?
Compression, trauma or other damage to the spinal canal that contains the cauda equina
What are the potential cause of cauda equina syndrome?
- Herniation of a lumbar disc
- Tumours
- Trauma
- Infection
- Epidural abscess
- Congenital defects
- Spondylolisthesis
- Late-stage ankylosing spondylitis
- Post-operative haematoma
Herniated discs at what levels most commonly cause cauda equina syndrome?
- L4/5
- L5/S1
What tumours can cause cauda equina syndrome?
- Metastases
- Lymphoma
- Spinal tumours
What congenital defects can cause cauda equina syndrome?
- Congenital spinal stenosis
- Kyphoscoliosis
- Spina bifida
What are the risk factors for disc herniation?
- Male
- Heavy lifting
- Middle age
What is the period of onset for most cases of cauda equina syndrome?
Suddent onset with rapid progression within hours to days
How can cauda equina syndrome rarely present?
With a slowly evolving painless onset
Do all patients have a complete cauda equina syndrome?
No, 30-50% have a partial syndrome
What are the symptoms of cauda equina syndrome?
- 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
What urinary dysfunctions may occur in cauda equina syndrome?
- Retention
- Difficulty starting or stopping stream
- Overflow incontinence
- Decreased bladder or urethral sensation
What bowle dysfunctions may occur in cauda equina syndrome?
- Faecal incontinence
- Constipation
- Loss of anal tone and sensation on rectal examination
How is cauda equina syndrome typically diagnosed?
Clinical diagnosis
What can assist the clinical diagnosis of cauda equina syndrome?
Radiological imaging
What is the preferred imaging modality for confirming a diagnosis of cauda equina syndrome?
MRI
What can MRI also show in cauda equina syndrome?
The level of compression and underlying cause
When can suspected cauda equina syndrome be ruled out?
Only if refuted by MRI
