Cauda Equina

Question 1

Presenting Complaints and examination

Answer 1

Double incontinence, saddle paraesthesia (or general), bilateral sciatica, limb weakness, erectile dysfunction, BACK PAIN.

Exam:

Lower limb exam. Neuro and MSK.

TPR, sensation coordination.
PR exam for anal tone.
Abdo for urinary retention.

Question 2

Investigations

Answer 2

Urgent MRI whole spine.

Bloods - FBC, UandE, CRP.

Question 3

Management

Answer 3

TandO referral for emergency spinal decompression.

Pain relief, abx if indicated, urinary catheter, 16mg dexamethasone.

General advice:
OT/PT for rehabilitation of limb usage.
Weight loss, sick note/alter jobs.