Cauda Equina Syndrome

Question 1

incidence

Answer 1

1:65000 per yr

Question 2

5 other causes

Answer 2

spinal stenosis
tumours
trauma [retropusion of fracture fragment]
spinal epidural haematoma
epidural abscess

Question 3

most common cause

Answer 3

disc herniation

Question 4

CES is a —— motor neuron lesion

Answer 4

lower

Question 5

symptoms

Answer 5

pain in back of thighs/legs
numbness saddle/back of legs/soles of feet
weakness motor in lower limbs
atrophy of calves if insidious onset
paralysis of dysfunction of bladder and bowel
absence of lower limb reflexes
decreased rectal tone

Question 6

onset may be insidious or

Answer 6

acute

Question 7

PHx

Answer 7

cancer

undiagnosed neoplasm

Question 8

what cancers can metastasise to bones

Answer 8

breast
lung
prostate
thyroid
renal
colon

Question 9

most common sites for tumour mets

Answer 9

lung
liver
bone - axial skeleton thoracic spine
- prox limb girdle prox femur

Question 10

if mets detected, median survival for thyroid cancer

Answer 10

48 months

Question 11

if mets detected, median survival for prostatic adenocarcinoma

Answer 11

40 months

Question 12

if mets detected, median survival for breast cancer

Answer 12

24 months

Question 13

if mets detected, median survival for renal cell carcinoma

Answer 13

variable but can be 6 months

Question 14

if mets detected, median survival for lung cancer

Answer 14

6 months

Question 15

red flags

Answer 15

CES
Severe pain esp at night/lying down
hx of cancer
thoracic pain
structural deformity
hx of violent trauma
age under 20 or over 55
neuro disturbances
fever night sweats wt loss
immunosuppression eg HIV IVDU Steroids

Question 16

yellow flags

Answer 16

belief pain/activity is harmful
low mood, social withdrawal
over reaction
non-dermatomal sensory loss
inconsistent signs
superficial non-anatomical tenderness
pain with stimulated testing axial loading or pelvic rotation
problems with claims and compensation
problems at work, poor job satisfaction