Cauda Equina Syndrome Flashcards
What is cauda equine syndrome?
rare but serious neurological condition affecting the nerve roots at the lower back of the spine. The cauda equine supplies innervation to the LEX , spine and function of the bladder
Risk factors and epidemiology of CES
Compression in 45% of CES causes are due to a herniated lumbar disc, L4-L5 or L5-S1
Any ages but particularly adults 20-50
Obesity
Recent lumbar spine surgical interventions
Spinal stenosis- narrowing of the spinal canal a
Trauma
Tumours
Infections- certain conditions like epidural abscesses can lead to compression
Clinical presentations of CES
Bilateral neurogenic sciatica, pain with lower back and bilateral/unilateral legs
Reduced perineal sensation, loss of sensation in ht e saddle region
Altered bladder function, increased frequency, difficulty, change in stream, inconstancy and retention
Loss of anal tone, bowel inconstancy, inability to control motions, inability to feel when bowel is full
Loss of sexual function, important aspect not commonly spoken about
Systemic effects of CES
Loss of bladder and bowel control
Sexual dysfunction
LEX weakness or paralysis, depending on extent or nerve involvement
Sensory defects, numbness or tingling in the saddle region
Differential diagnosis of CES
Lumbar radiculopathy
Multiple sclerosis
Syringe myalgia
Peripheral neuropathy
Spinal cord injury
Lower back strain
Lumbar disc herniation
Pathology of CES
Compression of the cauda equine bundle of nerves which can result from various causes; disc herniation, spinal stenosis, tumours, trauma, infections. Compression leads to ischemia and subsequent dysfunction of the affected nerve roots, resulting in a range of neurological symptoms
Treatment of CES
Primary is surgical, relieves pressure
Decompression surgery, laminectomy
Steroid administrative- corticosteroids to reduce inflammation
Rehabilitation- post surgery for optimal recovery
A and e referral
