Cauda Equina Flashcards
Outline the symptoms/signs of cauda equina compresson.
- Lower back pain
- Sciatica (often unilateral)
- Saddle anaesthesia
- Impotence
- Urinary retention
- Overflow incontinence
- Loss of anal tone
- Motor weakness in lower limbs
- Sensory loss to lumbosacral regions
- Reduced reflexes
Outline some of the associated causes of cauda equina syndrome.
- Bony metastasis
- Myeloma
- Epidural abscess
- Disc prolapse
- Epidural haematoma
- Primary sacral tumour e.g. chordoma
What is the most common cause of cauda equina?
Disc prolapse
Once you suspect cauda equina, what must you do?
The patient needs urgent same day assessment by spinal surgeon, imaging and then surgical decompression as appropriate – this must be done within hours and even waiting until the next day may allow irreversible damage and paralysis to occur.
MRI whole spine.
How may you differentiate compression of the cord itself from cauda equina?
- Cauda equina compression causes flaccid paralysis with loss of reflexes.
- Cord compression usually causes spastic paralysis with brisk reflexes.
- Both cause sensory and power loss.
Outline 3 sinister causes of cauda equina.
- Spinal fractures – sudden onset of severe central spinal pain, a history of major trauma, point tenderness over a vertebral body.
- Cancer – age >50, gradual onset of symptoms, unexplained weight loss, no symptomatic improvement in pain after four to six weeks of conservative therapy, past or current history of cancer.
- Infection – fever, diabetes, IVDU, immuno-suppression (HIV)
Which sensory dermatome corresponds with the sole of the foot?
S1.
Which sensory dermatome corresponds with the upper anterior thigh?
L2.
Which sensory dermatome corresponds with the groin?
L1.
Which sensory dermatome corresponds with the buttock?
S3.
Which sensory dermatome corresponds with the calf?
L4.
