CAUDA EQUINA SYNDROME

         

lower motor neurone compression….

1. Urinary retention – flaccid bladder + detrusor
2. Faecal incontinence – flaccid voluntary sphincter
3. Flaccid paralysis of lower limbs
4. Saddle anaesthesia (S1-S4)
5. Bilateral loss of ankle jerk (S1)
6. Compression of multiple nerve roots – bilateral sciatica is worse prognosis

May not have ALL signs

Monitor for gradual progression of symptoms – repeat examinations

Ask “When was the last time you walked?”

If >48 hours since onset of symptoms, unlikely to see much improvement after surgical intervention

 

Causes:

Disc herniation – young more common

Abscess – elderly, immunocompromised, IVDU

tumour – mets, lymphoma

 

Examination tips:

Flex hips – remove tension on iliopsoas when lying flat

Flex knees ot 45 degrees

Clear commands

Can’t fake collapsing weakness

sensation in dermatome distribution

Ankle jerk – cross ankle over opposite ankle with foot in cocked position

PR – key to S1-S4 sensation, also anal tone – check after relax then repeat tone