Can cauda equina be misdiagnosed?

Cauda Equina Syndrome is frequently misdiagnosed. However, this can have terrible consequences, as cauda equina is a condition that must be treated immediately if a patient is to regain normal function.

What can mimics cauda equina syndrome?

Elsberg syndrome is a rare infectious syndrome that mimics cauda equina syndrome. 3 It is an acute, bilateral lumbosacral myeloradiculitis, which characteristically occurs secondary to herpes virus infection. Most commonly, HSV-2 is the causative pathogen, but VZV is also a well-recognised aetiological agent.

Can cauda equina syndrome be missed on MRI?

A large number of patients do not have cauda equina syndrome (CES) on MRI to account for their clinical findings; consequently, the majority of urgent scans requested are normal.

How do you rule out cauda equina?

Magnetic resonance imaging (MRI): the best method of imaging the spinal cord, nerve roots, intervertebral discs, and ligaments. Since these scans can detect damage or disease of soft tissue, MRIs are valuable in diagnosing the cause of cauda equina syndrome.

Can you have cauda equina with normal MRI?

Approximately 75% of patients sent for an MRI scan with suspected cauda equina syndrome will have a negative result. In other words, they do not have cauda equina syndrome. In such cases medical practitioners can rule out nerve compression and must consider an alternative diagnosis.

Delayed Diagnosis or Treatment Claims for Cauda Equina Syndrome

What is the most sensitive finding in cauda equina syndrome?

The sensitivity and specificity of the exam findings were highest for bulbocavernosus reflex (BCR) (100% and 100%), followed by rectal tone (80% and 86%), postvoid residual bladder (80% and 59%), and perianal sensation (60% and 68%).

Can cauda equina come on slowly?

Cauda equina syndrome can have a rapid onset with sudden severe symptoms, but it can also develop slowly, with early symptoms that often mimic other conditions. Recognizing these early symptoms is essential for a prompt diagnosis and appropriate treatment by experienced neurosurgeons in northern New Jersey.

Can you have partial cauda equina?

Partial cauda equina syndrome means there is still some executive bladder control. When a patient goes into painless urinary retention, the condition is complete. Cauda equina syndrome progresses from 'partial' or 'incomplete' to 'established' or 'complete'.

How do I know if I have cauda equina?

There are several red flags that you might have cauda equina syndrome: Numbness or different sensations in the backs of your legs, butt, hip and inner thighs (your saddle area, as in the parts of your body that would touch the saddle if you were on a saddled horse). Pain in your back and/or legs (sciatica).

When should you suspect cauda equina syndrome?

Symptoms of Cauda Equina Syndrome

If you have any of these symptoms, see your doctor right away: Severe low back pain. Pain, numbness, or weakness in one or both legs that causes you to stumble or have trouble getting up from a chair.

Does an MRI always show nerve compression?

Conclusions. There is lack of sufficient high quality scientific evidence in support or against the use of MRI in diagnosing nerve root compression and radiculopathy.

Can cauda equina be without back pain?

It is possible for a patient to develop cauda equina syndrome with no history of back pain, or in a patient with a long or recent history of low back pain or sciatica.

Can cauda equina be seen on CT scan?

CT-PTSE <50% appears to reliably rule out cauda equina impingement. This imaging marker may serve as an additional tool for the clinician in helping to decide whether MR imaging can be deferred, and it has the potential to lower associated health care costs.

Can cauda equina affect one side?

Typical symptoms of cauda equina syndrome include: Neurological symptoms in the lower body. Weakness, tingling, or numbness in the legs, and/or feet on one or both sides of the body is a common symptom.

Is walking good for cauda equina syndrome?

Pelvic floor exercises can assist with regaining bladder control and gentle aerobic exercise such as walking can help restore strength in the lower back and legs.

How common is cauda equina syndrome?

Cauda equina syndrome is a relatively rare condition, comprising around 2–6% of lumbar disc operations [16, 17, 31], with an incidence in the population thought to be between 1 in 33,000 to 1 in 100,000 [1].

What are red flags for cauda equina?

Red flag symptoms

Bilateral sciatica (pain and altered sensation in the legs) Bladder dysfunction such as having to strain or an altered flow or altered awareness of the need to urinate. Tingling or numbness in the saddle area between the legs and around the anus. Alteration of sexual sensation.

What level does cauda equina start?

[1] The cauda equina is a group of nerves and nerve roots stemming from the distal end of the spinal cord, typically levels L1-L5 and contains axons of nerves that give both motor and sensory innervation to the legs, bladder, anus, and perineum.

What is incomplete cauda equina syndrome?

Patients have an incomplete cauda equina syndrome (CESI) if they have subjective and/or objective evidence of neurological losses such as impaired bladder sensation, impaired urethral sensation, impaired rectal sensation and/or objective genital/peri-anal (S3–S5) sensory disturbance and/or reduction in anal tone, ...

Are there different levels of cauda equina syndrome?

The dural sac and cauda equina were compressed at multiple levels, including L3-4, L4-5, and L5-S1. Myelography revealed severe dural sac compression with bilateral involvement.

Is cauda equina worse at night?

Severe nerve-type (neurogenic) pain may require prescription pain medication with side effects that may cause further problems. If the pain is chronic, it may become "centralized" and radiate to other areas of the body. Neurogenic pain tends to be worse at night and may interfere with sleep.

How long can you have cauda equina syndrome?

Once extensive nerve damage happens, the consequences will be permanent. There may be some improvement in a patient's condition in the years following the cauda equina compression. However, medical practitioners normally advise that after five years a patient cannot expect to see any further improvement.

Can sciatica turn into cauda equina?

While rare, sciatica caused due to severe disc herniation(s) in the lower spine may progress into cauda equina syndrome.

Does xray show cauda equina syndrome?

Plain radiography is often helpless in detecting the cause of cauda equina syndrome but might be useful in searching of destructive changes, disk-space narrowing, or spondylolysis. MRI and CT scan are the gold standard tests for cauda equina syndrome diagnosis.

Does MRI for cauda equina need contrast?

MRI with gadolinium contrast of the lumbosacral area is the diagnostic test of choice to define pathology in the areas of the conus medullaris and cauda equina (see the images below). It provides a more complete radiographic assessment of the spine than other tests; plain x-rays and CT scan may be normal. ^{[85, 82]} .