Cauda Enquina Syndrome, paraplegia and tetraplegia

Question 1

What is Cauda Enquina Syndrome? MX?

Answer 1

• Cauda equina syndrome is caused by compression, trauma, or damage to cauda equina.
• It is a medical emergency
• Mx = Decompressive surgery of spine

Question 2

Name 4 causes of Cauda Enquina Syndrome

Answer 2

(1. ) Lumbar disc herniation (most common)
(2. ) Spinal stenosis
(3. ) Ankylosing spondylitis
(4. ) Trauma to spine

Question 3

Name Sx of Cauda Enquina Syndrome (5)

Answer 3

(1. ) Sexual + Bowel/bladder dysfunction
- urinary retention, incontinence
- decreased bladder + urethral sensation etc.
- faecal incontinence and constipation

(2. ) Saddle anaesthesis
(3. ) Low back + leg pain - unilateral or bilateral lower limb motor and/or sensory abnormality
(4. ) Paraplegia (loss of muscle control in legs)

• > Remember SPINE: Saddle Anaesthesia, Pain, Incontinence, Numbness, emergency
• > Lower back pain + loss of groin sensation plus bladder and bowel incontinence -> think CES

Question 4

What innervations do the Cauda Enquina carry?

Answer 4

Lumbar and Sacral nerves. These carry innervations for:

(1. ) Genitals
(2. ) Anal sphincter
(3. ) Detrusor muscle
(4. ) Leg muscles
(5. ) Knee and ankle reflexes
(6. ) Skin sensation of legs and pelvis

Question 5

What Q’s/steps would you think about when Dx in neurology?

Answer 5

(1. ) Is it unilateral or bilateral
(2. ) UMN or LMN or NMJ origin?
(3. ) Weakness: proximal, distal, pyramidal? from brain to skeletal muscle?
(4. ) Sensory loss: glove and stocking?, sensory level? dermatomal or peripheral nerve?

Question 6

What is paraplegia?

Answer 6

Partial or total paralysis of the lower body

Question 7

What is TETRAplegia?

Answer 7

Partial or total paralysis of ALL FOUR LIMBS and torso

Question 8

What are the causes for para and tetraplegia?

Answer 8

(1. ) Vehicular accidents
(2. ) Falls
(3. ) Act of violence
(4. ) less common: tumour, CNS lesions, stroke, cerebral palsy, MS etc

Question 9

Pathophysiology of para and tetraplegia

Answer 9

• Injury to the brain or SC that prevent signalling to the lower body (paraplegia) or whole body (tetraplegia)

Question 10

Complications of para and tetraplegia

Answer 10

(1. ) Pressure Sores (due to lack of movement)
- Blood flow to tissue is cut off, resulting in tissue death
- Sores make the pts more susceptible to infections

(2. ) Muscle spasticity
(3. ) Muscle atrophy
(4. ) Thrombosis
(5. ) Chronic pain/Neuropathic pain
(6. ) Bladder and bowel problems
(7. ) Mental health issues

(8. ) Specific to tetraplagia: resp problems
- lung collapse or pulmonary infections

Question 11

Tx and Mx of para and tetraplegia

Answer 11

There is no tx to reverse this

(1. ) Physio and occupational therapy
(2. ) Medications: muscle relaxants, anticoag, pain killers
(3. ) Devices to support mobility
(4. ) Surgery could be necessary

Question 12

6 Red flags for cauda equina syndrome

Answer 12

(1. ) Bilateral sciatica
(2. ) Severe or progressive bilateral neurological deficit of the legs, such as major motor weakness with knee extension, ankle eversion, or foot dorsiflexion.
(3. ) Difficulty initiating micturition or impaired sensation of urinary flow
(4. ) Loss of sensation of rectal fullness
(5. ) Perianal, perineal or genital sensory loss (saddle anaesthesia or paraesthesia)
(6. ) Laxity of the anal sphincter

Question 13

1st line Ix of CES?

Answer 13

Urgent MRI scan of lumbar