Cauda Equina Syndrome

Abstract

Cauda equina syndrome (CES) is a potentially devastating neurological condition in which the lumbosacral nerve roots become compressed. Signs and symptoms are lower extremity weakness, paraplegia, sensory changes, muscle atrophy, absent/reduced reflexes, and bowel, bladder, and sexual dysfunctions. Assess lower extremity strength, sensation, reflexes, tone, gait, proprioception, anal sphincter tone, and perianal sensation. “Saddle anesthesia” of the perineum, inner thighs, and/or buttocks is a telling sign. MRI of the lumbosacral spine can demonstrate neurological compromise of the cauda equina. The treatment is immediate neurosurgical evaluation or referral to the emergency room. Refer to physiatry for subacute/chronic issues.