cauda equina syndrome
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Etiology
- most common
- lumbar stenosis
- spinal trauma including vertebral fractures
- herniated nucleus pulposus
- massive, centrally herniated disc (most common)
- neoplasms
- metastases
- astrocytoma
- neurofibroma
- meningioma; 20% of all spinal tumors affect this area
- spinal infection or epidural abscess
- tuberculosis
- herpes simplex virus
- meningitis
- meningovascular syphilis
- cytomegalovirus
- schistosomiasis
- postoperative complications
- spina bifida & subsequent tethered cord syndrome
- rare
- spinal hemorrhage compressing the spinal canal
- intravascular lymphomatosis
- congenital anomalies
- conus medullaris lipomas
- multiple sclerosis
- spinal arteriovenous malformations
- late-stage ankylosing spondylitis
- neurosarcoidosis
- deep venous thrombosis of the spinal veins (propagated)
- inferior vena cava thrombosis
Pathology
- external compression on a sheath of nerve roots from the lower cord segments
- loss of sphinter control (bowel & bladder)
Clinical manifestations
- acute low back pain[2]
- radicular pain[2]
- saddle anesthesia (perianal or perineal sensory loss)
- lower motor neuron signs
- bilateral motor weakness of the lower extremities
- knee extension
- ankle flexion, dorsiflexion or eversion
- decreased muscle tone, areflexia[2]
- bilateral motor weakness of the lower extremities
- bowel & bladder dysfunction are usually late manifestations & do not occur in all patients[2]
- urinary retention (most common presentation)*
- urinary incontinence
- fecal incontinence, lax anal sphincter
* clearly at odds with previous statement, but substantiated in ref[2]
Laboratory
- see preoperative laboratory testing
- CSF analysis of no value
Radiology
- magnetic resonance imaging (MRI)
- computed tomography (CT) if MRI unavailable
Management
- immediate neurosurgical consultation
- glucocorticoids of no benefit if due to hematoma[2]
- may be of benefit if due to trauma
More general terms
Additional terms
References
- ↑ Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 745
- ↑ Jump up to: 2.0 2.1 2.2 2.3 2.4 2.5 2.6 2.7 2.8 Medical Knowledge Self Assessment Program (MKSAP) 11, 15, 17, 18, 19. American College of Physicians, Philadelphia 1998, 2009, 2015, 2018, 2021
- ↑ Dawodu ST and Lorenzo N eMedicine: Cauda Equina and Conus Medullaris Syndromes http://emedicine.medscape.com/article/1148690-overview#aw2aab6b2b4
- ↑ Gitelman A, Hishmeh S, Morelli BN et al Cauda equina syndrome: a comprehensive review. Am J Orthop (Belle Mead NJ). 2008 Nov;37(11):556-62. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19104682
- ↑ Long B, Koyfman A, Gottlieb M. Evaluation and management of cauda equina syndrome in the emergency department. Am J Emerg Med. 2020;38:143-148. PMID: https://www.ncbi.nlm.nih.gov/pubmed/31471075