Test 1: Lecture 6, Cauda Equina

Question 1

what is cauda equina syndrome

Answer 1

rare condition where lumbosacral nn roots are compressed within the lumbosacral spinal canal

Question 2

hallmarks of CES

Answer 2

1. bilateral neurogenic sciatica (likely back pain and symptomatic unilateral/bilateral leg symptoms)
2. reduced perianal sensation (sensation loss in saddle area)
3. altered bladder function leading to painful retention (wide range of changes to urinary control may be possible)
4. Loss of anal tone (fecal incontinence likely)
5. Loss of sexual function (decrease ability for erection, decreased sensation)

Question 3

types of CES presentation

Answer 3

acute - with S&S of lumbar disc herniation

chronic - after long hx of LBP

gradual/progressive development in days to weeks

Question 4

CES epidemiology

Answer 4

5-10 out of 100000

rare

develops in 2-3% pts with disc herniation

may not see in career

Question 5

CES etiology

Answer 5

typically caused by central disc prolapse at L4/5 or L5/S1

can also be caused by disc infection or tumor

Question 6

CES red flags

Answer 6

reduced bladder filling awareness

loss of urge to void

reduced awareness that miturition is occuring

recent onset or progressively worsening weakness of urinary control (dribbling)

loss of urethral sensation

loss of peri anal sensation

inability to tell if bladder is full or empty

inability to stop bowel movements from leaking

inability to tell when you have had a bowel movement

change in ability to achieve an erection and ejaculate

loss of genital sensation

Question 7

physical exam findings cauda equinA

Answer 7

decreased sensation in dermatomes

diminished myotomes

hyporeflexive DTRs

no UMN S&S

some diminished proprioception

rectal exam for sphincter control

Question 8

CES arrival at ED: what tests and measures will likely be done

Answer 8

ultrasound of bladder

MRI

CT only if MRI is unavailable

Question 9

CES surgery types

Answer 9

CES is sx emergency

usually requires decompression

may need stabilization as well if unstable after decompression

sx in first 48 hours of acute onset S&S improves outcomes

Question 10

CES blowel and bladder management

Answer 10

will need help with this
may need foley cath initially
depends on severity of injury; may require self cath
will need bowel program
it would be an LMN focused bowel program
nursing/physicians/PT/OT all edu on this

Question 11

balance and gait considerations for CES

Answer 11

LMN injury

likely will have partial leg innervation

may start in a WC but may progress to balance and gait

Question 12

LMN syndrome S&S

Answer 12

hypotonia
areflexic/absent DTRs
flaccid bowel and bladder
no UMN S&S
psychogenic sexual function
no spasticity but may have fasciculations

Question 13

acute care exam/eval for CES

Answer 13

chart review to see if pt has precautions

subjective hx

first 72 hours ASIA

check skin and environment

check vitals

DTRs

UMN S&S

basic mobility

Question 14

acute care intervention for CES

Answer 14

edu
- injury
- skin
-bowel/bladder

positioning

range

basic mobility

out of bed to WC

bracing or WC needs?

D/C planning (Outpatient vs acute care)

Question 15

acute rehab exam/intervention

Answer 15

sensory/motor presentaiton
pain
skin
edu carryover
basic monility
bracing/custom seating
UMN signs
reflexes
goals
home set up

Question 16

intervention for acute rehab with CES

Answer 16

all mobility!

balance, bed mobility, scooting, transfers, WC propulsion, pre-gait, gait

contact CPO (orthotics) or ATP (WC)

edu on injury/caregiver home management

return to community tasks

Question 17

outpatient eval/exam for CES

Answer 17

sensory/motor presentation
pain
skin
edu carryover
basic mobility
need for bracing
UMN signs
relfexes
goals
home set up
screen secondary injuries

Question 18

outpatient interventions for CES

Answer 18

higher level balance and gait
higher level WC
higher level ADLs/home management
independence for bowel/bladder
return to sport
return to work/school/community