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Cauda Equina Syndrome is a SURGICAL EMERGENCY! it is usually the result of massive disc herniation, and many nerves can be compressed in the cauda equina. It usually occurs acutely, and there can be:

  • Impaired sphincter responses (e.g. difficult micturating, post voidal incontinence)
  • Altered perianal sensation (saddle anaesthesia)
    • Decreased anal tone
  • LMN signs in the lower limbs
Rapid imaging and surgical decompression are needed to maintain function. MRI is preferred, but CT can also be used to confirm the diagnosis.
Metastatic disease should be suspected in a patient with history of weight loss and CES
Prognosis – mainly depends upon the time the nerves were decompressed for. Some patients will have permanent damage, whilst others will regain varying degrees of function over varying timescales.
Differential Causes of Nerve Root compression
  • Neoplasm
  • Skeletal disorders – e.g. spondylosis, RA, Paget’s Disease
  • Infection – e.g. TB or abscess
  • Trauma
  • Vascular disease – e.g. haemorrhage


  • Murtagh’s General Practice. 6th Ed. (2015) John Murtagh, Jill Rosenblatt
  • Oxford Handbook of General Practice. 3rd Ed. (2010) Simon, C., Everitt, H., van Drop, F.
  • Beers, MH., Porter RS., Jones, TV., Kaplan JL., Berkwits, M. The Merck Manual of Diagnosis and Therapy

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