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Cauda Equina Syndrome Reviewed 10/2010

Daniel Morris, Kyan J. Berger
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BASICS

  • Description
  • Risk Factors
  • Etiology

DIAGNOSIS

  • Signs and Symptoms
  • Essential Workup
  • Tests
  • Differential Diagnosis

TREATMENT

  • Pre-hospital
  • Initial Stabilization
  • ED Treatment
  • Medication (Drugs)
  • In-patient Considerations
The following is an excerpt....
BASICS
Description

Compression of lumbar and sacral nerve fibers in cauda equina region:

  • Nerve fibers below conus medullaris
  • Fibers end at L1–L2 interspace.
Risk Factors
  • Neoplasm
  • IV drug use
  • Immunocompromised state
Etiology
  • Herniated disc most common:
    • L4–L5 discs > L5–S1 > L3–L4
    • Most common in 4th and 5th decades of life
  • Mass effect from:
    • Myeloma, lymphoma, sarcoma, meningioma, neurofibroma, hematoma
    • Spine metastases (breast, lung, prostate, thyroid, renal)
    • Epidural abscess (especially in IV drug users)
  • Blunt trauma
  • Penetrating trauma
  • Spinal anesthesia

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See Also
Images >
1 2
Figure 6-76 NON-CONTAINED DISC: CAUDA EQUINA SYNDROME. A. T2-Weighted MRI, Sagittal Lumbar Spine. Observe the non-contained L5-S1 disc (sequestered free fragment) that has migrated caudally (arrow). B. T1-Weighted MRI, Axial Lumbar Spine. Note the large, intermediate signal intensity disc fragment (arrow) compressing and displacing the cauda equina posteriorly. COMMENT: The symptoms of bowel and bladder incontinence, sensory disturbance, and motor weakness in the lower extremities suggest the presence of cauda equina syndrome and warrant immediate neurosurgical referral. This patient underwent emergency surgical decompression.Credit: Terry R. Yochum, Lindsay J. Rowe, Yochum And Rowe's Essentials of Skeletal Radiology, Third Edition. Philadelphia: Lippincott Williams & Wilkins, 2004.