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Cauda equina syndrome

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Definition

Acute loss of neurological function in the nerve roots below the end of the spinal cord (usually below about L1, L2).

Epidemiology

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Essentially, many of the things that cause cauda equina syndrome are incredibly serious. The damage, if untreated, can become permanent.

Pathophysiology

For every cause, pressure is put on or direct damage is done to the nerves in the cauda equina.

Clinical Features

  • Urinary and faecal incontinence - reduction in sphincter power
  • Saddle anaesthesia (losing feeling in the bits of you that would touch a saddle - genitals, perineum, anus. That sort of area.)
  • Lower motor neurone weakness - reduced power, tone and reflexes. Can lead to paralysis.
  • Back pain and leg pain - radicular pain (along a dermatome) down legs

Conus medullaris syndrome

The conus medullaris is just above the cauda equina (T12-L1). Lesions here tend to cause urinary retention and constipation.

Investigations

  • MRI and CT scans are done to accurately pinpoint nature and site of lesion. Occasionaly, urodynamics is done.

Management

Surgery, immediately in order to get out whatever it is that is causing the problem. If surgery is not possible, radiotherapy is the next option for tumours.

In connective tissue disorders, treat the connective tissue disorder.

Prognosis

The later the diagnosis and the greater the extent of the pain and neurological deficit, the worse the prognosis.