Daily Bolus of LR: Cauda Equina Syndrome

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February 10, 2011 by dailybolusoflr

Cauda equina syndrome


Fast Facts:


·         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


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