Cauda Equina Syndrome (2*)

Question 1

What’s its most common cause?
→ What are its other causes?

What does the cauda equina supply?

Answer 1

➊ Lumbar disc herniation at L4/5 and L5/S1 discs
→ • Tumour
• Abscess
• Trauma

➋ • Sensation to Perineum, Bladder, Rectum
• Motor to Anal & Urethral sphincters, and lower limbs
• Parasympathetic to Bladder and Rectum

Question 2

What are its key presenting symptoms?

What else does it present with?

How is it investigated?

How is it managed?

Answer 2

➊ • Lower back pain
• Saddle anaesthesia - Does it feel normal when you wipe after opening your bowels?
• Bilateral sciatica
• Bowel/bladder disturbance

➋ • Leg weakness
• Sexual dysfunction
• Loss of anal tone on DRE

➌ Whole spine MRI

➍ • Lumbar decompression
• If malignancy is suspected or seen on MRI, give Dexamethasone 16 mg (with PPI cover)