Cauda Equina Syndrome Flashcards
What is Cauda Equina Syndrome?
The cauda equina is formed by nerve roots caudal to the level of spinal cord termination. Cauda equina syndrome (CES) is caused by compression of the nerves, causing one or more of the following: bladder and/or bowel dysfunction, reduced sensation in the saddle (perineal) area, and sexual dysfunction, with possible neurological deficit in the lower limb (motor/sensory loss, reflex change)
What is the aetiology of Cauda Equina Syndrome?
Herniation of a lumbar disc; the most common cause of CES is compression arising from large central lumbar disc herniation at the L4/L5 and L5/S1 level
Can be due to tumour, trauma, infection
How does Cauda Equina Syndrome present?
Most cases are of sudden onset and progress rapidly within hours or days
Low back pain
Lower limb motor weakness and sensory deficits (loss of reflexes)
Bowel and/or bladder dysfunction
Rectal examination may reveal loss of anal tone and sensation.
How would you diagnose Cauda Equina Syndrome?
The diagnosis of CES is primarily based on a thorough history and clinical examination, assisted by appropriate radiological investigation
The only way to exclude the diagnosis of CES is with an emergency MRI scan
How would you manage Cauda Equina Syndrome?
Urgent surgical spinal decompression is indicated for most patients to prevent permanent neurological damage
What are the complications that can follow Cauda Equina Syndrome?
Paralysis.
Sensory abnormalities.
Bladder, bowel and sexual dysfunction.
What is the prognosis for Cauda Equina Syndrome?
Patients with bilateral sciatica or complete perianal anaesthesia have a less favourable prognosis than patients with unilateral pain
What nerves are often affected in cauda equina?
L4/L5
