Cauda equina syndrome

Question 1

Aetiology of cauda equina syndrome?

Answer 1

Cauda equina damage/compression

The cause is usually a disc herniation in the lower region of the back.

Other causes include spinal stenosis, cancer, trauma - lifting etc, epidural abscess, and epidural hematoma.

Question 2

presentation of cauda equina syndrome?

Answer 2

low back pain,

pain that radiates down the leg,

Weakness of legs bilaterally

saddle anaesthesia s3-5 dermatome

loss of bowel or bladder control.

sexual dysfunction

absent achilles reflex

gait disturbance

Onset may be rapid or gradual

Question 3

how do we mx cauda equina syndrome?

Answer 3

herniated disk early surgical decompression by means of laminectomy

if sudden onset - is an emergency

Question 4

Case; a man presents with cauda equina type symptoms but has a sensory level at T7- likely diagnosis

Answer 4

likely an inflammatory myelopathy

bcos shouldnt have the sensory level in CES

Question 5

what is an inflammatory myelopathy? aetiology?

Answer 5

Myelopathy is the result of compression of the spinal cord and nerve roots caused by in this case inflammation but also

arthritis, trauma, rheumatoid arthritis, bone spurs and spinal degeneration due to aging.

Myelopathy can also take an acute form or result from a spine deformity at birth.

inflammatory myelopathy is aka transverese myelitis

Question 6

presentation of inflammatory myelopathy/ Transverse myelitis?

Answer 6

motor weakness, a sensory impairment below the lesions, and bowel and bladder dysfunction.

typically develop bilateral weakness, usually involving the legs, although the arms may also become affected,

pattern of sensory changes that suggests a spinal cord dermatomal level - sensory level!

Bowel and bladder impairment is also common in many patients.

difficulty with fine motor skills

difficulty with balance and coordination

Question 7

Ivx for inflammtory myelopathy?

Answer 7

Critical: Lumbar puncture + CSF analysis - confirms myelitis if WCC is high

gram stain CSF: -ve if no infection

xray - rule out other causes

MRI of the spine - visualise cord, exclude compressive myelopathy

AQP4 and myelin antibodies - prognostic

emg - to determine nerve root affected

myelography

Question 8

which nerve roots when impacted can affect your balance?

Answer 8

thoracic

Question 9

mx for transverse myelitis?

Answer 9

1. Steroids; methylpred
   1b. Supportive care
2. Plasma exchange