CAUDA EQUINA SYNDROME
lower motor neurone compression….
- Urinary retention – flaccid bladder + detrusor
- Faecal incontinence – flaccid voluntary sphincter
- Flaccid paralysis of lower limbs
- Saddle anaesthesia (S1-S4)
- Bilateral loss of ankle jerk (S1)
- 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