Cauda Equina Flashcards
What is CES?
Surgical emergency caused by compression of cauda equina
What is the cauda equina?
Horse tail nerves at bottom of spinal cord
S2-4
What are the cauda equina symptoms a combination of? (2 things)
Neuromuscular + urogenital symptoms
What does the cauda equina nerve bundle supply? (3 things)
- Motor and sensory innervation to lower limbs
- Motor innervation to anal sphincters
- Parasympathetic innervation of bladder
What are the causes of cauda equina? (7 things)
Compresssion of cauda equina bc:
- Disc herniation (most common)
- Spinal stenosis (2nd common)
- # / trauma
- Cancer (thyroid / breast / lung / renal / prostate)
- Infection
- Congenital
- Vascular
What are some differential diagnosis of CES? (5 things)
- Mechnical Back Pain
- Guillain-Barré Syndrome
- Lumbar Disc Disorders
- Cancer
- Spinal Cord Infections / injuries
What are the clinical features of CES? (9 things)
- Back pain
- Bladder / bowel dysfunction
- Urinary retention
- Erectile dysf
- Loss of sexual sensation
- Loss of anal tone
- Reduced leg sensation
- Leg motor weakness
- Hypoflexia
What clinical feature should you make sure you check for in CES?
Why?
Bladder dysf (esp for retention)
- Confirmed retention = complete CES
- Reduced ability to void (loss of desire / sensation) = incomplete CES
What should you check for in examination of sus CES? (2 things)
- PR exam
2. Post-void bladder scan
What are the 3 classifications of CES?
- CES w Retention (CESR)
- Incomplete CES (CESI)
- Sus CES (CESS)
What are the characteristics of CESR? (2 things)
- Complete retention
2. Overflow incontinence
What are the characteristics of CESI? (2 things)
- Loss of desire to void
- Less sensation
- Poor stream
- Need to strain
What is the gold standard investigation for CES?
MRI
What are the management options for CES? (4 things)
- Urgent surgical decompression
- High dose steroids (dexamethasone) – reduce localised swelling
- Immobilisation if trauma
- Chemo/ radiotherapy if malignancy
