Thursday, 16 September 2010

MRCP revision battle 13.4: Cauda Equina Syndrome

Cauda equina syndrome refers to a set of features caused by compression of the cauda equina.

The cauda equina begins in most people at around L1/L2.

Features of cauda equina syndrome include:
  • low back pain
  • sciatica
  • urinary incontinence/retention
  • faecal incontinence/retention
  • variable motor/sensory loss
  • classically saddle/perianal paraesthesia

Causes of cauda equina are logical when you think about it, you just need to consider what could be there to press on it:
  • commonest = large central disc herniation at L4/L5 or L5/S1
  • tumours
  • trauma
  • epidural abscess (consider this one in MRCP questions that mention a 'post op patient')
  • post op haematoma (another reason to look out for that 'post-op patient')
  • IVC thrombus
  • ankylosing spondylitis
  • sarcoidosis

Treatment is urgent surgery.

So to the final (and juiciest) battle of the day, surviving sepsis...