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Cauda Equina Syndrome, Emergency Medicine

Daniel F. Morris Reviewed 06/2017
 


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

  • Immunocompromis...

Diagnosis

Signs and Symptoms

History

  • Low back pain

  • Sciatica/radicular pain (unilateral or bilateral)

  • Lower-extremity numbness or weakness

  • Difficulty ambulating owing to weakness or pain

  • Bladder or rectal dy...

Treatment

Pre-Hospital

  • Manage airway and traumatic injuries as indicated.

  • If evidence of trauma, patient should be transported with full spine immobilization.

Even in nontrauma patient, consider spinal i...

Follow-Up

Disposition

Admission Criteria

  • All patients with acute cauda equina syndrome must be admitted to neurosurgical service.

  • Patients have good prognosis with rapid surgical decompression.

  • Treatment ...

Pearls and Pitfalls

Ideally, diagnose patients in early phase before irreversible neurologic dysfunction: 
  • Back pain out of proportion

  • Fever and back pain

  • Back pain in high-risk groups; screen with ESR/C...

Additional Reading

  • Fraser  S, Roberts  L, Murphy  E. Cauda equina syndrome: A literature review of its definition and clinical presentation. Arch Phys Med Rehabil.  2009;90(11):1964–1968.

  • Hussain ...

Codes

ICD9

  • 344.6 Cauda equina syndrome

  • 344.60 Cauda equina syndrome without mention of neurogenic bladder

  • 344.61 Cauda equina syndrome with neurogenic bladder

ICD10

G83.4 Cauda equina syndrome 

SNOMED

  • 192970...

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