Cauda Equina Syndrome

1. Cauda Equina Syndrome
Ben Savage

2. Contents
What is it
Symptoms
Causes
Investigations
Treatment
Prognosis
Prevention

3. Cauda equina syndrome
Cauda equina syndrome is caused by a
significant narrowing of the spinal canal
that compresses the spinal cord and causes
nerve problems bellow the level of the
compression
Condition is a surgical emergency

4. Symptoms
Leg pain, weakness, anaesthesia
Saddle anaesthesia
Bladder dysfunction
Decreased anal tone
Sexual dysfunction
Absence of ankle reflex

5. Causes
Congenital
Meningomyelocoele
Congenital Dermoid sinus
Congenital Midline Tumours: dermoid, epidermoid, teratoma, lipoma
Acquired
Infectious: Neurosarcoidosis, Schistosomiasis, Abscess formation
Traumatic: Road traffic accident, Fall from height, Penetrating injuries -
gunshot, stabbing
Degenerative: Central disc prolapse
Neoplastic: Primary – Ependymoma, Neurofibroma, Meningioma,
Secondary metastasis
Vascular: Arteriovenous malformations
Iatrogenic: Anaesthetic, Orthopaedic and Neurosurgical procedures,
Lumbar arachnoiditis following radiculogram

6. Investigation
Bloods
FBC, U&E, LFT, CRP
CXR
Spinal x-rays
ECG
MRI spine

7. Treatment - Medical
Treat any underling cause of compression
Infection – antibiotics
Inflammation – anti-inflammatories
Tumours – Radio/ chemotherapy

8. Treatment - Medical
However
If symptoms do not begin to improve within
24hr then surgery.
Or
If symptoms continue to deteriorate
immediate surgery.

9. Treatment - Surgical
Surgical decompression
Drainage
Laminectomy
Fixation of fracture
Removal of foreign body

10. Prognosis
Patient who have bilateral leg pain have a poorer
prognosis than those with unilateral pain.
Patient with complete groin numbness are more
likely to have permanent bladder paralysis.
The extent of saddle anesthesia is one of the most
important prognostic indicators.

11. Prevention
Control of any predisposing underlying
pathology.
Early diagnosis and treatment are
crucial

12. Summary
Cauda equina syndrome is a surgical
emergency
Present with wide variety of symptoms
Early diagnosis and treatment are
crucial for good recovery

13. References
Clare J. Fowler, Neurology of Bladder, Bowel, and Sexual
Dysfunction: Blue Books of Practical Neurology, Volume
23. 1999
JASON C. http://www.emedicinehealth.com/cauda
_equina_ syndrome/page8_em.htm#Surgery. 11/5/09
http://www.3dchem.com/moremolecules.asp?
ID=189&othername=Cataflam 11/5/09
http://www.patient.co.uk/showdoc/40000789/ 11/5/09
http://img.medscape.com/fullsize/migrated/482/043/nf482
043.fig4.jpg 11/5/09