Cauda Equina Syndrome

Question 1

Where does the cauda equina begin?

Answer 1

L2

Question 2

What is the conus medullaris?

Answer 2

Section of the spinal cord which is tapered down at L1 and L2

Question 3

What are the causes of cauda equina syndrome?

Answer 3

Herniated disc (most common)

Tumours

Spondylolisthesis

Abscess

Trauma

Question 4

What are the red flags of cauda equina syndrome?

Answer 4

Saddle anaesthesia

Painless urinary retention

Faecal incontinence

Bilateral sciatica

ED

Question 5

What does a PR show with cauda equina syndrome?

Answer 5

Reduced anal tone

Question 6

How is cauda equina syndrome managed?

Answer 6

Immediate hospital admission

Emergency MRI

Lumbar decompression surgery

Question 7

Why does surgery need to be done as soon as possible?

Answer 7

Increases chances of regaining function

May still have bladder, bowel or sexual dysfunction

Motor and sensory impairment can also persist

Question 8

What is the difference between metastatic spinal cord compression and cauda equina syndrome?

Answer 8

Metastatic lesion compression of the spinal cord not the cauda equina

Question 9

What is a key feature of metastatic spinal cord compression?

Answer 9

Back pain is worse on coughing or straining

Question 10

Why do you get UMN sings with metastatic spinal cord compression?

Answer 10

Spinal cord is being compressed higher up before LMN have exited the spinal cord thus UMN will be seen

Question 11

What treatments are used for metastatic spinal cord compression?

Answer 11

High dose dexamethasone (reduces swelling in tumour relieves compression)

Analgesia

Surgery

Radiotherapy and chemotherapy