February 10, 2011 by dailybolusoflr
Cauda equina syndrome
· It is not a true cord syndrome, but rather a syndrome which affects the cluster of lumbar and sacral nerve roots that continue distal to the cord and are known as the cauda equina or “horse’s tail.”
· The most common etiology of cauda equina is a midline rupture of the intervertebral disc and the most common location is L4-L5.
· Level of suspicion should be raised when patients complain of low back pain and bilateral motor or sensory findings, especially in the “saddle” or perineal region.
o Patients may note decreased sensation when they wipe after using the bathroom
· Patients may also complain of urinary or fecal incontinence, but urinary retention (which may manifest as overflow “incontinence”) is more commonly present.
o The most consistent finding present in patients with cauda equina syndrome is urinary retention (sensitivity 90%).
· Patients may have decreased DTR’s, but this is not a classic finding.
· Suspicion of cauda equina syndome is an indication for emergent MRI.
(Marx, 1391-1392; Wolfson, 728-729)
Linda Regan, MD FACEP
Program Director, Emergency Medicine Residency
Johns Hopkins Medical Institutions