Cauda Equina Syndrome

Question 1

What is cauda equina syndrome?

Answer 1

A serious condition in which the lumbosacral nerve roots that extend below the spinal cord are compressed

Question 2

How does cauda equina syndrome present?

Answer 2

Low back pain
Bilateral sciatica
bilateral distal leg weakness
Reduced sensation/pins-and-needles in the perianal area
Decreased anal tone
Urinary dysfunction- incontinence

Question 3

What is the main cause of cauda equina syndrome?

Answer 3

Central disc prolapse- L4/5 or L5/S1

Question 4

What are other possible causes of cauda equina syndrome?

Answer 4

Tumours: primary or metastatic
Infection: abscess, discitis
Trauma
Haematoma

Question 5

What investigation would you carry out for cauda equina syndrome?

Answer 5

Urgent MRI of spine

Question 6

What is the management of cauda equina syndrome?

Answer 6

Urgent surgical decompression within 48 hours.

Question 7

What is the problem with someone presenting with urinary incontinence?

Answer 7

Incontinence is a late sign that may indicate irreversible damage

Question 8

When should you be highly suspicious of a diagnosis of cauda equina syndrome?

Answer 8

Acute onset dysfunction of bowel, bladder or both, accompanied by altered perianal ‘saddle’ sensation is cauda equina syndrome until proven otherwise