Cauda Equina Syndrome Overview Cauda Equina Syndrome: • Prevalence: 1:33,000-100,000 ppl/yr • Incidence: 1.5-3.4 million ppl/yr • Urgent condition due to severe compression of nerve roots of lumbar spine • MCC- acute lumbar disc herniation • Involves lumbar spine L1-L5 Symptoms - Cauda equina syndrome (CES) is usually characterized by these so-called ‘red flag’ symptoms: • Severe low back pain (LBP) • Sciatica: often bilateral but sometimes absent, especially at L5/S1 with an inferior sequestration • Saddle and/or genital sensory disturbance • Bladder, bowel and sexual dysfunction SPINE Mnemonic: • S - Saddle anesthesia • P - Pain • I - Incontinence • N - Numbness • E - Emergency Causes of Cauda Equina Syndrome: • large lower lumbar disc herniation, prolapse or sequestration • epidural hematoma • infections • primary and metastatic neoplasms • trauma • post surgical • prolapse after manipulation • after chemonucleolysis • after spinal anaesthesia • ankylosing spondylitis • gunshot wounds • constipation Differential Diagnosis: • Spinal cord infarct • HIV related myelopathy • Transverse myelitis • Multiple sclerosis • Syringomyelia • Spinal AVM • Multilevel lumbar stenosis • Vascular intermittent Claudia toon • Spinal infection/abscess • Ankylosing spondylitis • Tethered cord • Guillain-Barre syndrome • Neurosarcoidosis • Multiple sclerosis • Diastematomyelia Physical Exam: • Inspection - lower extremity muscle atrophy • Palpation - lower back pain/tenderness is not a distinguishing feature - palpation of the bladder for urinary retention • Neurovascular Examination - bilateral or unilateral lower extremity weakness and sensory disturbances - decreased or absent lower extremity reflexes - reduced or absent sensation to pinprick in the perianal region (S2-S4 dermatomes), perineum, and posterior thigh - decreased rectal tone or voluntary contracture • Provocative Tests - diminished or absent bulbocavernosus reflex - diminished or absent anal wink test - reflex contraction of the external anal sphincter upon pinprick stimulation of skin around the anus Laboratory studies: • CBC, ESR, CRP • Urodynamic studies (PVR) Imaging studies: • MRI- Sagittal, axial T1 and T2 Treatment: • Surgical decompression #CaudaEquina #Cauda #Equina #syndrome #differential #diagnosis #causes #neurology
