Cauda Equina Syndrome Flashcards
What is the most common cause of cauda equina syndrome?
Compression from a large central lumbar disc herniation at the L4/L5 or L5/S1 level
What is meant by ‘cauda equina’?
The bundle of nerve roots located below the termination of the spinal cord
How does cauda equina syndrome differ from acute cord compression in terms of neurological findings?
Cauda equina causes lower motor neuron signs, whereas acute cord compression presents with upper motor neuron signs
Name three non-compressive causes of cauda equina syndrome
- Polyradiculopathy
- Radiation therapy effects
- Ankylosing spondylitis
What is the significance of saddle anaesthesia in cauda equina syndrome?
It indicates sensory loss in the perineal and genital area, a key red flag for cauda equina
What bladder symptom is most classically associated with cauda equina syndrome?
Urinary retention
Why is constipation not considered a typical red-flag symptom for cauda equina?
Because cauda equina affects control/awareness of bowel and bladder, not the function itself like constipation
What neurological exam finding on PR (per rectal) exam suggests cauda equina syndrome?
Loss of anal sphincter tone
What does a palpable suprapubic mass suggest in someone with suspected cauda equina syndrome?
Bladder distension due to urinary retention
What is the first-line investigation for suspected cauda equina syndrome?
Urgent MRI of the lumbar spine, including lower thoracic spine
What is the definitive treatment for cauda equina syndrome caused by disc herniation?
Urgent surgical decompression or discectomy
What are two potential long-term complications of cauda equina syndrome?
Permanent bladder and bowel dysfunction, and the possible need for urinary diversion or colostomy
Given new bilateral sciatica, even with a normal examination
Same day urgent MRI - admit to the hospital
What is a late sign seen in cauda equina syndrome?
Urinary incontinence
A 56-year-old man presents with acute on chronic back pain radiating down the leg. He reports that he has had back pain for the last five years, which he attributes to his desk job as an accountant. However, he reports that after flipping his mattress to air it, the pain is much worse. On palpation, he is most tender over L2 and L3.
He is complaining of pins and needles in his feet. On direct questioning, he admits that he has lost continence of his bowel and bladder. He is unable to feel the wiping of the toilet paper over his back passage when he passes a motion
What imaging needs to be urgently done?
Whole spine MRI scan
What is the most appropriate initial management?
IV Dexamethasone 16mg STAT
A 72-year-old man presents with acute back pain, bilateral leg weakness and lower abdominal pain. Examination reveals flaccid paralysis of both legs, with a sensory level of L3 on both sides of the midline.
Abdominal palpation reveals a grossly distended bladder with no other organomegaly or lymphadenopathy. MRI scan of his spine shows an L3 vertebral body fracture with compression of the cauda equina. The radiologist comments that the L3 vertebral body, as well as several other vertebral bodies, have sclerotic areas within them
What is the underlying diagnosis?
Metastatic prostate cancer
In cases of a radial nerve injury, what hand deformity is commonly observed?
Wrist drop
