Cauda Equina Syndrome Red Flags
What is Cauda Equina Syndrome?
CES is the compression of a collection of nerve roots, shaped like a horse’s tail, called the cauda equina and is located at the bottom of the spinal cord. CES is uncommon, but it’s important to pay attention to the red flag symptoms because they might indicate various health issues.
Because of the cauda equina nerves, you can move and feel sensations in your legs and urinary bladder. Compressed cauda equina nerves can cause pain, weakness, incontinence, and other symptoms. This syndrome can cause permanent damage, including paralysis, if left untreated. Swift diagnosis and treatment may help prevent permanent damage like paralysis.
Diagnosis & Treatment
Experts estimate that around 1 in 65,000 people will develop cauda equina syndrome and the serious condition affects males and females equally. In the UK, there is an average of 5 cases per year in A&E of cauda equina syndrome. The most common cause is a significant lumbar disc herniation compressing the roots of the cauda equina in the lower lumbar spine. An average GP will see one case every 15-20 years, and most will never see a case. Delayed diagnosis and treatment may lead to irreversible incapacitating disability, so it is critical that you understand and recognise the ‘red flags’ to identify cauda equina syndrome. The signs and symptoms that should raise concern include bilateral sciatica, bowel symptoms, urinary symptoms, erectile dysfunction, progressive bilateral neurological dysfunction. Think of the acronym ‘SPINE’ below:
‘S’ – Saddle Anaesthesia
‘P’ – Pain
‘I’ – Incontinence
‘N’ – Numbness
‘E’ – Emergency
When any one of these symptoms are present, a patient should be referred urgently to A&E. CES is a time sensitive diagnosis, patients are therefore encouraged to know the signs and ask the simple question: ‘Could this be cauda equina syndrome?’
MRI and CT scan are the gold standard tests for cauda equina syndrome diagnosis. Unfortunately, there is no conservative care for CES with emergency surgical decompression usually the treatment of choice to try stop permanent damage.
There are different types on CES, firstly acute CES, which is of rapid onset, with severe symptoms starting suddenly and surgery will be required within 24-48 hours. The second type of CES is called chronic or long lasting CES whereby the individual will have had symptoms of CES for a gradual period of time and, where surgery doesn’t repair the nerves, there is permanent damage and unfortunately lifelong symptoms for the individual. Acute CES is a medical emergency whereas chronic CES may be more difficult to diagnose.
Case Study – Meet Adam.
Adam started to first experience pain in his back which progressively got worse. He said that on one occasion it was so bad that he was unable to go to work. He was also experiencing trouble with his legs. He went to his GP and was told to take painkillers and if he felt any numbness to go to A & E. Some weeks later he started to feel a pins and needles sensation and he could hardly move. He went to A & E. whilst there he was seen by a doctor and given painkillers. The doctor explained that there was nothing he could do. Following this visit he could barely move and could barely get into a taxi and home. He rang his GP but couldn’t move so he cancelled. He lost all bladder function, and the paramedics were sent for. Adam had an operation however during all of this he was not made aware of Cauda Equina Syndrome (CES) and had no idea that this is what he had. Adam was told by his consultant that there is a two-year recovery period and if he remained symptomatic after two years, it was likely that his symptoms would be permanent. Unfortunately, Adam was classified as suffering from acute and complete CES with lifelong symptoms such as permanent pain and/or numbness, incontinence, sexual dysfunction and even paralysis.
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