Cauda Equina Syndrome Clinical Features [Neurosurgery Wiki]

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====== Cauda Equina Syndrome Clinical Features ======

It could lead to bladder and bowel disturbances, impairment of sexual functions, perianal or saddle numbness and neurological symptoms in lower limbs
((Todd NV. Cauda equina syndrome: findings on perineal examination. Br J Neurosurg. 2013;27:852.))
((Abuzinadah A, Almalik Y, Shabani-Rad MT, Ho CH, George D, Alant J, Zochodne D. Cauda equina syndrome secondary to intravascular lymphoma. Neurol Clin Pract. 2012;2:158–161.)).

Approximate area of "saddle anesthesia" seen from behind 

Severe back pain

Saddle anesthesia, i.e. anesthesia or paraesthesia involving S3 to S5 dermatomes, including the perineum, external genitalia and anus; or more descriptively, numbness or "pins-and-needles" sensations of the groin and inner thighs which would contact a saddle when riding a horse.

===== Sphincter Disturbance =====

Usually produces [[urinary retention]], although sometimes [[urinary incontinence]] may occur (some cases are overflow incontinence).

Bladder and bowel dysfunction, caused by decreased tone of the urinary and anal sphincters. detrusor weaknesses causing urinary retention and post-void residual incontinence as assessed by bladder scanning the patient after the patient has urinated.

Sciatica-type pain on one side or both sides, although pain may be wholly absent

Weakness of the muscles of the lower legs (often paraplegia)

Achilles (ankle) reflex absent on both sides.

Sexual dysfunction

Severe back pain, saddle anesthesia, incontinence and sexual dysfunction are considered "red flags", i.e. features which require urgent treatment.