Cauda Equina Syndrome (CES)
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Overview

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.
Cauda equina syndrome secondary to abscess as seen on MRI
Cauda equina syndrome secondary to abscess as seen on MRI. by Jing Jing Chan and Jen Jen Oh is licensed with CC BY 4.0

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

References

  • 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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Dr Tom Leach

Dr Tom Leach MBChB DCH EMCert(ACEM) currently works as a GP Registrar and an Emergency Department CMO in Australia. He is also a Clinical Associate Lecturer at the Australian National University. After graduating from his medical degree at the University of Manchester in 2011, Tom completed his Foundation Training at Bolton Royal Hospital, before moving to Australia in 2013. He started almostadoctor whilst a third year medical student in 2009. Read full bio

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