Cauda equina syndrome Flashcards
(33 cards)
Define cauda equina syndrome?
Rare form of spinal stenosis that is characterised by compression of multiple lumbar and sacral nerve roots of the cauda equina
Define spinal stenosis?
Too little space inside backbone
What spinal nerves, and their nerve roots, make up the cauda equina?
L2-L5
S1-S5
Coccygeal nerve
What are the 2 main actions of the cauda equina?
Innervation of pelvic organs
Motor function of lower limbs
Is cauda equina syndrome more common in men or women?
Equally common
Is cauda equina syndrome more common in adults or children?
More common in adults
What are the 2 most common causes of cauda equina syndrome in children?
Spinal injury
Spinal congenital abnormality
What is the incidence of cauda equina syndrome in the general population?
1 in 65,000 people affected
Which 2 factors determine the severity of symptoms of cauda equina syndrome?
Degree of nerve root compression
Which specific nerve roots are compressed
What is the most common red flags symptom of CES, and why is it the most important symptom to identify?
Most common red flag symptom is urinary function
Degree of urinary function distinguishes between early/partial and late/complete CES
What 4 sites make up the ‘saddle area’?
Perineum (area between anus and scrotum/vulva)
Anus
Genitals
Buttocks
What are the 2 stages of CES?
Early/partial CES
Late/complete CES
How is the saddle area affected in early CES compared to late CES?
Early CES: patient has altered sensation in saddle area
Late CES: patient has no sensation in saddle area
How is ability to urinate affected in early CES compared to late CES?
Early CES: patient has less desire to urinate/void full bladder and produces small urine volume voluntarily
Late CES: patient has painless urinary retention (inability to voluntarily urinate/void full bladder) so produces no urine voluntarily and has overflow incontinence
Why do patients with late CES have painless urinary retention?
They have no sensation in saddle area, so will not feel unpleasant feeling when they have a full bladder
Why does urinary retention lead to overflow incontinence in late CES patients?
Patient is unable to voluntarily urinate due to loss of saddle area sensation, eventually bladder will fill capacity and overflow due to complete loss of bladder function
How is the bladder function affected in early CES compared to late CES?
Early CES: patient still has some bladder function and control, might have stress incontinence
Late CES: patient has complete loss of bladder function and control, will have overflow incontinence
Give 4 red flag symptoms of CES that don’t involve urinary function?
Sexual dysfunction (eg. women have painful intercourse, men have erectile dysfunction)
Weakness and paralysis in lower limbs
Faecal incontinence due to loss of function of anal sphincter muscles
Lower back pain
Give 6 differential diagnosis of CES?
spinal metastasis, ankylosing spondylitis, discitis, osteoporotic compression fractures, sciatica, spondylosis
Give 4 important symptoms that can be identified from patient history, in investigation of CES?
Has patient experienced sexual dysfunction such as painful intercourse, erectile dysfunction
Has patient had lower back pain
Has patient had numbness, pain in legs and feet
Has patient had urinary symptoms
What 3 factors are tested in physical examination, for investigation of CES?
Sensation, muscle strength, reflexes
In legs and feet
Give 3 findings of CES in a physical examination of lower limbs?
Diminished/no knee and ankle jerks
Negative babinski sign
Bilateral leg pain
What is the plantar reflex test, and what are the normal and abnormal findings?
Plantar reflex test: Simulation lateral palmar aspect of foot causes movement of hallux (big toe)
Normal finding: hallux flexion, which is a negative babinski sign
Abnormal finding: hallux extension, which is a positive babinski sign
Give 3 imaging mediums that can be used for radiological investigation of CES?
MRI
CT
Myelogram (Spinal canal X-ray)
