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.

What can be mistaken for cauda equina?

Urinary tract infection: because of the change in urinary habit, Cauda Equina Syndrome is regularly mistaken for a urinary tract infection.

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.

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.

What is the difference between cauda equina syndrome and conus medullaris syndrome?

The symptoms and signs of cauda equina syndrome tend to be mostly lower motor neuron (LMN) in nature, while those of conus medullaris syndrome are a combination of LMN and upper motor neuron (UMN) effects (see Table 1, below).

Managing cauda equina syndrome–Neurology Masterclass

Can cauda equina come and go?

Onset of Cauda Equina Syndrome

In an acute onset, sensory and motor deficits in the lower body typically develop within 24 hours. Gradual onset can develop over progressively, and symptoms may come and go over the course of several weeks or months.

At 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 impending cauda equina?

The cauda equina is the continuation of these nerve roots in the lumbar and sacral region. These nerves send and receive messages to and from the lower limbs and pelvic organs. Cauda equina syndrome (CES) occurs when there is dysfunction of multiple lumbar and sacral nerve roots of the cauda equina.

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, ...

Can a CT scan detect cauda equina syndrome?

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 you see cauda equina on xray?

Plain radiography is unlikely to be helpful in cauda equina syndrome but may be performed in cases of traumatic injury or in search of destructive changes, disk-space narrowing, or spondylolysis.

Can cauda equina syndrome develop slowly?

Gradual onset cauda equina syndrome is when the condition occurs slowly, with symptoms getting progressively worse over a matter of weeks, months or even years. During this period, the symptoms of cauda equina syndrome may seem to come and go, with certain symptoms improving before deteriorating again.

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.

How can you tell the difference between cauda equina and sciatica?

The causes of Cauda Equina Syndrome are similar to sciatica except that in CES, the compression is being applied to the cauda equina nerves located at the bottom of the spine. It shares some of the same symptoms as sciatica, but there are some big red flags that indicate CES rather than sciatica: Severe back pain.

Can cauda equina be missed?

One of the reasons that cauda equina syndrome can go undiagnosed or misdiagnosed is because it is relatively rare. It involves extreme compression of the nerves at the end of the spinal cord.

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'.

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.

Is cauda equina always bilateral?

Cauda equina syndrome (CES) is usually characterised by these so-called 'red flag' symptoms: Severe low back pain (LBP) Sciatica: often bilateral but sometimes absent, especially at L5/S1 with an inferior sequestration.

Can cauda equina be painless?

Complete cauda equina syndrome is typically characterised by painless urinary retention with overflow incontinence.

How does cauda equina affect the bowel?

The cauda equina nerves are responsible for controlling an individual's awareness of the sensation around the anus. They are also responsible for the control of bowel movements. If those nerves become compressed or squashed, an individual may lose control of their bowel and sensation around the anus.

Why is cauda equina so rare?

Unlike other well-known back conditions such as sciatica and scoliosis, Cauda Equina Syndrome (CES) is relatively unheard of. This is in part because it is an uncommon condition, and also because – providing it is diagnosed and treated quickly – there is often a positive outcome for the patient.

What are the symptoms of L3 nerve root compression?

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 saddle paraesthesia feels like?

Saddle paresthesia – numbness and tingling along the inner thighs and lower groin, the areas that would be in contact if you were sitting in a saddle. Bowel incontinence – problems holding in urination or defecation.

How quickly does cauda equina progress?

Unlike most back problems that are longstanding or chronic, cauda equina is an acute event, like a stroke or heart attack. It most often develops rapidly, within as few as 6 to 10 hours.