cauda equina Flashcards
what is cauda equina?
A rare condition where the lumbosacral nerve roots are compressed within the lumbosacral spinal canal
what are the 5 hallmarks of CES?
bilateral neurogenic sciatica
reduced perianal sensation - saddle area
altered bladder function leading to painless urinary retention
loss of anal tone - fecal incontinence
loss of sexual function
what are the 3 presentations of CES?
acute with symptoms of lumbar disc herniation
chronic with long history of LBP
gradually progressive manner in days to weeks
epidemiology of CES:
- common or rare?
- develops in ____% of those with disc herniation
- rare: 5-10/1,000,000
- 2-3%
how is CES typically caused?
central disc prolapse at L4/5 or L5/S1
OR disc infection or tumor
what are some red flags of CES?
slide 8
what setting can undiagnosed CES often show up in?
outpatient orthopedic
what should you do if you notice a cluster of symptoms consistent with CES?
refer
–> you noticed hyporeflexive DTRs, (+) SLR, and bowel/bladder changes
if acute where should you refer a CES patient to? what about chronic?
acute: ER
chronic: PCP w/ urgent neurologist referral
your patient showing CES symptoms arrived in the ED. what would the physical findings be in the ED?
- dermatomes
- myotomes
- DTRs
- UMN signs
- Proprioception
- rectum???
- diminished
- diminished
- hyporeflexive
- No UMN signs
- problematic
- rectal exam for sphincter control
what imaging would be performed in the ED for someone with CES?
ultrasound of bladder
MRI -> want to know subtle details for surgical intervention
** CT only if MRI is unavailable
true or false. CES is NOT a surgical emergency
false - it is
typically a ________ surgery is required, but they may need _____ as well if still unstable after decompression
decompression
stabilization
surgery in the first _____ hours of acute onset improves outcomes. why?
48 hours
stops compression on the cord
will a patient with CES require help with bowel/bladder management? if so, what would they require?
yes
foley catheter initially
depending on severity –> self catheterization
LMN focused bowel program
nursing/MD/PT/OT all educate
how is balance and gait affected in those with CES?
likely have partial innervation of legs
may start w/c but progress to balance and gait
may need bracing
a patient with CES is a __(UMN/LMN)___ syndrome.
what would the exam findings be?
LMN
hypotonia
areflexia/absent DTRs
flaccid bowel and bladder
no UMN signs
psychogenic sexual function
no spasticity but may have fasciculations
you are a PT working in acute care. You got orders to see a patient post-surgery for CES. what’s your next steps?
chart review to see if pt has precautions
subjective history
first 72 hours - ASIA
check skin, environment, vitals
DTRs
UMN signs
basic mobility
what are some interventions for CES in acute care?
education on injury, skin protection, bowel/bladder
positioning
ROM
basic mobility tasks
out of bed to w/c
assess for bracing or w/c needs
d/c planning (OP vs. IP)
you are a PT working in acute rehab. a CES patient just arrived and you are to do an exam/eval on them. what are you checking?
sensory/motor
pain
skin
education carryover
basic mobility
need for bracing/custom seating
UMN signs
reflexes
goals
home set up
what interventions are you focusing on for CES in acute rehab?
balance, bed mobility, scooting, transfers, w/c propulsion, pre-gait, gait
contact CPO or ATP
education on injury patient/family caregiver management at home
return to community tasks
you are a PT working in OP neuro clinic. you have an eval for a pt with CES. what is one thing you are going to focus on that wasn’t checked in acute rehab?
secondary injuries (RTC, elbow, scoliosis)
what are interventions for CES in an OP clinic?
higher level balance/gait training
higher level w/c training
higher level ADLs/home management
independence with bowel/bladder management
return to sport
return to work/school/community activities
what are you looking for when chart reviewing before seeing a patient with CES?
notes from ED
imaging
post-op report –> precautions, stable?
