Cauda Equina syndrome

Question 1

Things to look for on examination

Answer 1

• PR exam - perianal anaesthesia, loss of anal tone
• Lower limb anaesthesia/weakness
• Urinary retention signs - distended bladder?

Question 2

Investigations for suspected CES

Answer 2

• PR exam
• Post void bladder scan
• Lumbar sacral MRI

Question 3

management of CES

Answer 3

• Urgent neurology review
• Needs urgent surgical decompression

Question 4

Time frame for good prognosis for CES

Answer 4

• To theatre within 24hrs of autonomic dysfunction = reduced bladder problems at long term f/u

Question 5

Poor outcomes following CES

Answer 5

• Bladder/bowel dysfunction
• Sexual dysfunction
• Chronic back/leg pain
• Parasthesia
• Weakness - paralysis?

Question 6

Where does cauda equina begin?

Answer 6

• where spinal cord ends at L2 ish
• End of spinal cord = conus medullaris

Question 7

Pathophysiology of CES

Answer 7

• Disc herniation - most common L4/L5 or L5/S1
• Trauma - vertebral # or subluxation
• Neoplasm - primary or mets
• Infection eg discitis
• Chronic spinal inflam - eg ank spond
• Iatrogenic - haematoma following spinal anaesthesia

Question 8

Classifcation of CES

Answer 8

• CES with retention - back pain, uni/bilateral sciatica, weakness, sensory disturbance, loss anal tone, loss urinary control
• Incomplete CES - as above but just altered urinary sensation instead of full loss
• Suspected CES - severe back and leg pains, variable neurological symptoms and signs, sphincter disturbance suggested

Question 9

What happens in incomplete CES with altered bladder sensation?

Answer 9

• Loss of desire to void
• Diminished sensation
• Need to strain
• Poor stream

Question 10

Differentials for CES

Answer 10

• SCC - but will have UMN signs
• Radiculopathy - but no faecal, sexual or urinary disturbance
• MSK - alter ROM but no neurological signs