Cauda equina syndrome (CES) is characterized by a constellation of symptoms resulting from compression of the cauda equina, a bundle of spinal nerves and nerve roots located at the lower end of the spinal cord. The symptoms can vary depending on the extent and location of the compression, but typically include:
Motor and sensory disturbances
- Lower limb weakness: Patients may experience weakness in the lower limbs, which can be bilateral and may progress over time
- Perineal numbness: Numbness in the perineal region is a common symptom, often described as "saddle anesthesia"
- Lower limb clonus: Although CES typically presents with lower motor neuron signs, atypical presentations with upper motor neuron signs such as lower limb clonus have been reported
Autonomic dysfunction
- Bowel and bladder incontinence: Autonomic dysfunction can lead to bowel and bladder incontinence, a significant symptom of CES
- Difficulty in urination: Patients may also experience difficulty in urination, which can be a result of the autonomic dysfunction associated with CES
Pain
- Lower back and radicular pain: Pain in the lower back and radicular pain are common symptoms of CES. The pain can be severe and may radiate to the lower limbs
In conclusion, CES is a neurosurgical emergency that presents with a combination of motor and sensory disturbances, autonomic dysfunction, and pain. The symptoms can vary depending on the extent and location of the compression, and atypical presentations should be acknowledged to avoid inappropriately rejected diagnoses