CAUDA EQUINA SYNDROM

CAUDA EQUINA SYNDROME INTERODUCATION:Cauda equina syndrome, nerves at the base of the spinal cord become compressed. This affects nerves important for messages to the legs, feet and pelvic organs.
Cauda equina syndrome is a medical emergency needing urgent hospital treatment to avoid permanent bladder and bowel problems.

Causes :-
Cauda equina syndrome occurs more often in adults than in children, but it can occur in children who have a spinal birth defect or have had a spinal injury.
* A herniation (bulging) of a spinal disk in the lumbar area that presses on the nerves (the most common cause).
* Narrowing of the spinal canal (stenosis).
* A spinal lesion or tumour( metastatic cancer and Paget’s diesease) or cancer
* A spinal infection( staphylococcus and tuberculosis bacteria ), inflammation
, haemorrhage or fracture.
* A complication from a severe lumbar spine injury such as a car crash, fall or other traumatic injury such as a stabbing.
* A birth defect such as an abnormal connection between blood vessels (arteriovenous malformation).

Symptom :-
Symptoms of cauda equina syndrome can develop suddenly, but may take weeks or months. The onset of the condition is often described using the following distinctions:
* Acute onset is marked by a rapid development of symptoms that often includes severe low back pain and significant loss of bladder and bowel function. 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. Gradual onset usually typically includes partial or intermittent loss of bowel and bladder function, as well as recurring low back pain in combination with muscle weakness and numbness and bladder and/or bowel incontinence or dysfunction. Sciatica may also occur in one or both legs.
* Loss of bowel or bladder function may include incontinence (inability to retain urine or stool), and/or constipation (inability to eliminate urine or stool).
* 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. Lower body weakness or numbness may make it difficult to walk or stand.
* Altered sensation in the “saddle region,” or saddle anesthesia. The saddle region is the area of the body that would be in contact with a saddle when sitting on a horse. This region includes the groin, the buttocks and genitals, and the upper inner thighs. With cauda equina syndrome, all or parts of this region may have neurological symptoms of numbness, tingling, and/or weakness.
* Sexual dysfunction that has come on suddenly.

Diagnosis :-
* A medical history, in which you answer questions about your health, symptoms and activity.
* A physical examination to assess your strength, reflexes, sensation, stability, alignment, and movements.:-
Physical examination for cauda equina or conus medullaris syndromes would be incomplete without tests for sensation of the saddle and perineal areas, bulbocavernosus reflex, cremasteric reflex, and anal sphincter tone, findings for all of which are likely to be abnormal.

Muscle strength of the following muscles should be tested to determine the level of lesion:
L2 – Hip flexors (iliopsoas)
L3 – Knee extensors (quadriceps)
L4 – Ankle dorsiflexors (tibialis anterior)
L5 – Big toe extensors (extensor hallucis longus)
S1 – Ankle plantar flexors (gastrocnemius/soleus)
Poor anal sphincter tone is characteristic of cauda equina syndrome. Babinski sign or other signs of upper motor neuron involvement suggest a diagnosis other than cauda equina syndrome, possibly spinal cord compression.
Physical examination for cauda equina or conus medullaris syndromes would be incomplete without tests for sensation of the saddle and perineal areas, bulbocavernosus reflex, cremasteric reflex, and anal sphincter tone, findings for all of which are likely to be abnormal.
* Magnetic resonance imaging (MRI) scan, which uses magnetic fields and computers to produce three-dimensional images of your spine.
* A myelogram – an X-ray of the spinal canal after injection of contrast material – which can pinpoint pressure on the spinal cord or nerves.
* A computed tomography (CT) scan.

Differential Diagnosis:-
Conus medullaris syndrome
Herniated Nucleus Pulposis
Lumbar disc herniation
Lumbar Radiculopathy
Lumbar vertebrae fracture
Lumbar spinal stenosis
Mechanical back pain
Peripheral neuropathy
Spinal cord compression
Spinal tumor
Sacral fractures
Abscesses
Lymphoma
Central or centerolateral disk prolapsed
Space-occupying lesions that compress nerve roots have been described as causes of CES.
Canal stenosis
Spinal Anesthesia
Neoplasm
Ischemia

Mangement:-
Medical treatment :
Depending on the cause of your CES, you may also need high doses of corticosteroids. These can reduce swelling. If you are diagnosed with an infection you may need antibiotics. If a tumor is responsible, radiation or chemotherapy may be needed after surgery.
Exercise :
Exercise is highly effective in restoring losses in strength and balance following a CES diagnosis. Regular physical activity can also be helpful when it comes to improving circulation and blood flow to the lower extremities — a common problem for those living with this condition. Consistent exercise can boost mood and decrease symptoms of depression, making it a must for those diagnosed with CES.

 

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