Cauda Equina Syndrome

Question 1

Etiology

Answer 1

1. PID (commonest)
2. Lumbar spinal stenosis
3. Secondary tumor
4. Primary tumor (Schwannoma, glioma)
5. Spinal abscess
6. Penetrating wound
7. Haematoma from epidural, spinal

Question 2

Clinical features

Answer 2

1. Dull aching back pain*
2. Sciatica pain (shooting)*
3. Numbness leg, tingling
4. Lower limb weakness (rare)
5. Saddle anaesthesia*
6. Bladder and bowel dysfunction*
7. Impotence

Question 3

Classification

Answer 3

Incomplete (cf)

Complete (cf)

Question 4

Physical examination

Answer 4

Neurological
1. LMNL

Rectal

1. Decrease anal tone
2. Anal wink test
3. Bulbocavernous reflex

Question 5

Investigation

Answer 5

MRI
CT Myelography (If contraindicated fr MRI)

Question 6

Why emergency?

Answer 6

If left untreated, can lead to permanent:

• bladder, bowel control
• sexual dysfunction
• paralysis

Question 7

Management

Answer 7

1. Surgical decompression (within 24 hours have good prognosis)