Cauda equina Flashcards
What is cauda equina syndrome?
Surgical emergency caused by a compression of the Cauda Equina
What actually is the Cauda equina?
Bundle of nerves inferior to the spinal cord
Where does the spinal cord taper to an end?
L1
What nerve roots pass down the spinal canal as the cauda equina?
L1-S5
What part of the body is affected by the cauda equina syndrome?
Motor and sensory to the Lower limb, motor to the anal spinchters and parasympathetic to the bladder
What can cause cauda equina syndrome?
Disc herniation, trauma, neoplasms, infection, chronic spinal inflammation, iatrogenic
What level is disc herniation most common?
L5/S1 and L4/L5
What are the most common cancers to metastasise to the spine?
thyroid, breast, lung, renal and prostate
What infection can cause cauda equina syndrome?
Discutais or potts disease
What can cause chronic spinal inflammation?
ankylosing spondylitis
What are some iatrogenic causes of cauda equina syndrome?
haematoma secondary to spinal anaesthesia
What are the symptoms of Cauda equina syndrome?
Reduced lower limb sensation, bladder or bowel dysfunction, lower limb motor weakness, severe back pain, impotence
On examination what will the features of Cauda Equina syndrome be?
Perianal or lower limb anaesthesia, loss of anal tone, urinary retention, lower limb weakness and hypoflexia
What are the 3 groups of cauda equina?
Cauda Equina syndrome with retention, Incomplete cauda equina syndrome, suspected cauda equina syndrome
What is Cauda Equina syndrome with retention?
back pain, sciatica, lower limb motor weakness, sensory disturbance in the saddle region, loss of anal tone and loss of urinary control
What is incomplete cauda equina syndrome?
Same as cauda equina with retention but will only have altered urinary sensation so loss of desire to void, diminished sensation and poor stream, need to strain
What is suspected cauda equina syndrome?
cases of severe back and leg pain with variable neurological symptoms and signs, and a suggestion of sphincter disturbance
Is cauda equina syndrome progressive?
Yes as will not usually immediately cause complete compression on the cauda equina, which is more likely to have recovery
What are some differential diagnosis for Cauda Equina syndrome?
Radiculopathy or cord compression
What investigations would be done for Cauda Equina syndrome?
Whole spine MRI
What is the management for Cauda equina Syndrome?
early neurosurgical review for urgent decompression, high dose steroids to reduce swelling, trauma immobilisation
What is the prognosis like for Cauda Equina syndrome?
If in theatre within 24 hours less likely to have bladder problems on follow up
