Cauda equina syndrome: Difference between revisions

Jump to navigation Jump to search
Line 124: Line 124:
*Transforaminal lumbar interbody infusion
*Transforaminal lumbar interbody infusion
*Microdiscectomy
*Microdiscectomy
Long term outcomes postsurgery are bladder, sexual and physical dysfunction especially in patients with cauda equina syndrome complete  with urinary retention.<ref name="pmid31263950">{{cite journal| author=Hazelwood JE, Hoeritzauer I, Pronin S, Demetriades AK| title=An assessment of patient-reported long-term outcomes following surgery for cauda equina syndrome. | journal=Acta Neurochir (Wien) | year= 2019 | volume= 161 | issue= 9 | pages= 1887-1894 | pmid=31263950 | doi=10.1007/s00701-019-03973-7 | pmc=6704093 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31263950  }} </ref>
Long term outcomes postsurgery are [[Urinary incontinence|bladder]], [[Sexual dysfunction|sexual]], and [[Cerebral palsy|motor]] dysfunction especially in patients with cauda equina syndrome complete  with urinary retention.<ref name="pmid31263950">{{cite journal| author=Hazelwood JE, Hoeritzauer I, Pronin S, Demetriades AK| title=An assessment of patient-reported long-term outcomes following surgery for cauda equina syndrome. | journal=Acta Neurochir (Wien) | year= 2019 | volume= 161 | issue= 9 | pages= 1887-1894 | pmid=31263950 | doi=10.1007/s00701-019-03973-7 | pmc=6704093 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31263950  }} </ref>


'''Primary Prevention'''
'''Primary Prevention'''

Revision as of 23:31, 14 July 2020

Cauda equina syndrome
Cauda equina and filum terminale seen from behind.
ICD-10 G83.4
ICD-9 344.6
DiseasesDB 31115
MeSH C10.668.829.800.750.700

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Joanna Ekabua, M.D. [2]

WikiDoc Resources for Cauda equina syndrome

Articles

Most recent articles on Cauda equina syndrome

Most cited articles on Cauda equina syndrome

Review articles on Cauda equina syndrome

Articles on Cauda equina syndrome in N Eng J Med, Lancet, BMJ

Media

Powerpoint slides on Cauda equina syndrome

Images of Cauda equina syndrome

Photos of Cauda equina syndrome

Podcasts & MP3s on Cauda equina syndrome

Videos on Cauda equina syndrome

Evidence Based Medicine

Cochrane Collaboration on Cauda equina syndrome

Bandolier on Cauda equina syndrome

TRIP on Cauda equina syndrome

Clinical Trials

Ongoing Trials on Cauda equina syndrome at Clinical Trials.gov

Trial results on Cauda equina syndrome

Clinical Trials on Cauda equina syndrome at Google

Guidelines / Policies / Govt

US National Guidelines Clearinghouse on Cauda equina syndrome

NICE Guidance on Cauda equina syndrome

NHS PRODIGY Guidance

FDA on Cauda equina syndrome

CDC on Cauda equina syndrome

Books

Books on Cauda equina syndrome

News

Cauda equina syndrome in the news

Be alerted to news on Cauda equina syndrome

News trends on Cauda equina syndrome

Commentary

Blogs on Cauda equina syndrome

Definitions

Definitions of Cauda equina syndrome

Patient Resources / Community

Patient resources on Cauda equina syndrome

Discussion groups on Cauda equina syndrome

Patient Handouts on Cauda equina syndrome

Directions to Hospitals Treating Cauda equina syndrome

Risk calculators and risk factors for Cauda equina syndrome

Healthcare Provider Resources

Symptoms of Cauda equina syndrome

Causes & Risk Factors for Cauda equina syndrome

Diagnostic studies for Cauda equina syndrome

Treatment of Cauda equina syndrome

Continuing Medical Education (CME)

CME Programs on Cauda equina syndrome

International

Cauda equina syndrome en Espanol

Cauda equina syndrome en Francais

Business

Cauda equina syndrome in the Marketplace

Patents on Cauda equina syndrome

Experimental / Informatics

List of terms related to Cauda equina syndrome

Overview

The cauda equina is a collection of nerves at the end of the spinal cord. Cauda equina syndrome is due to compression of these nerves. It is an emergency medical condition requiring acute intervention in the form of acute decompression surgery to prevent permanent neurological damage to the urinary bladder, Intestine, sex organs and lower limbs.

Historical perspective

Classification

Cauda equina syndrome may be classified into complete and incomplete.[1][2]

  • Cauda equina syndrome complete with urinary retention
  • Cauda equina syndrome incomplete
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Cauda equina syndrome
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Complete with urinary retention
 
 
 
 
 
 
 
 
 
 
 
Incomplete
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Lumbar +/- leg pain, sensory and motor deficency in lower extremities, painless urine retention with overflow incontinence, total perianal sensory loss, and fecal incontinece.
 
 
 
 
 
 
 
 
 
 
 
Lumbar +/- leg pain, sensory and motor deficency in lower extremities, loss of micturition reflex, altered urinary sensation and hesitancy, partial saddle anesthesia, and decreased anal sphinter tone.
 
 
 
 
 
 
 
 
 
 

Pathophysiology

Cauda equina syndrome is caused by compression of the lumbar and sacral nerves roots arising below the conus medullaris.[2]

Causes

Cauda equina syndrome may be caused by[3]

Differentiating cauda equina syndrome from other Diseases

Cauda equina syndrome must be differentiated from spinal disc herniation, epidural hematoma, spinal tumor, spinal stenosis, and diabetic amyotrophy.

Epidemiology and Demographics

The incidence of cauda equina syndrome is 2 per 100,000 world wide.[1]

Risk Factors

Screening

Natural History, Complications, and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

The most common symptoms of cauda equina syndrome include

Physical Examination


Laboratory findinds

X-ray

Ultrasound

CT Scan

Lumbosacral CT scan may be helpful in the diagnosis of cauda equina syndrome. Findings on CT scan suggestive of/diagnostic of cauda equina syndrome include

  • CT scans show herniated nucleus pulposus at the L4/5 level.

MRI

Lumbosacral MRI may be helpful in the diagnosis of cauda equina syndrome.[3][2] Findings on MRI suggestive of/diagnostic of cauda equina syndrome include

Other Imaging Findings

Other Diagnostic Findings

Treatment

Medical Treatment

Cauda equina syndrome is a medical emergency and requires prompt treatment. Although the mainstay of treatment is surgery, The following medications are used.[5]

  • 5.4 mg/kg·h of methylprednisolone (intravenous) for 2 days
  • 5 mg of dexamethasone (intravenous) every 12 h for 3 days
  • 0.5 mg of mecobalamin tablets (oral) every 8 h
  • Chemotherapy for cases due to tumors

Surgery

Surgery is the mainstay of treatment for cauda equina syndrome.[2][3] Immediate surgical decompression is the best intervention. Procedures used include

Long term outcomes postsurgery are bladder, sexual, and motor dysfunction especially in patients with cauda equina syndrome complete with urinary retention.[8]

Primary Prevention

Secondary Prevention

References

  1. 1.0 1.1 1.2 Srikandarajah N, Noble A, Clark S, Wilby M, Freeman BJC, Fehlings MG; et al. (2020). "Cauda Equina Syndrome Core Outcome Set (CESCOS): An international patient and healthcare professional consensus for research studies". PLoS One. 15 (1): e0225907. doi:10.1371/journal.pone.0225907. PMC 6953762 Check |pmc= value (help). PMID 31923259.
  2. 2.0 2.1 2.2 2.3 2.4 2.5 2.6 2.7 2.8 2.9 Srikandarajah N, Wilby M, Clark S, Noble A, Williamson P, Marson T (2018). "Outcomes Reported After Surgery for Cauda Equina Syndrome: A Systematic Literature Review". Spine (Phila Pa 1976). 43 (17): E1005–E1013. doi:10.1097/BRS.0000000000002605. PMC 6104724. PMID 29432394.
  3. 3.00 3.01 3.02 3.03 3.04 3.05 3.06 3.07 3.08 3.09 3.10 Luo D, Ji C, Xu H, Feng H, Zhang H, Li K (2020). "Intradural disc herniation at L4/5 level causing Cauda equina syndrome: A case report". Medicine (Baltimore). 99 (7): e19025. doi:10.1097/MD.0000000000019025. PMC 7035013 Check |pmc= value (help). PMID 32049799 Check |pmid= value (help).
  4. 4.00 4.01 4.02 4.03 4.04 4.05 4.06 4.07 4.08 4.09 4.10 Weng YC, Chin SC, Wu YY, Kuo HC (2019). "Clinical, neuroimaging, and nerve conduction characteristics of spontaneous Conus Medullaris infarction". BMC Neurol. 19 (1): 328. doi:10.1186/s12883-019-1566-1. PMC 6916224 Check |pmc= value (help). PMID 31847829.
  5. 5.0 5.1 5.2 5.3 5.4 5.5 5.6 5.7 Yuan T, Zhang J, Yang L, Wu J, Tian H, Wan T; et al. (2019). "Cauda equina syndrome without motor dysfunction following lumbar spinal stenosis surgery: A case report". Medicine (Baltimore). 98 (29): e16396. doi:10.1097/MD.0000000000016396. PMC 6709168 Check |pmc= value (help). PMID 31335689.
  6. Li P, Qiu D, Shi H, Song W, Wang C, Qiu Z; et al. (2019). "Isolated Decompression for Transverse Sacral Fractures with Cauda Equina Syndrome". Med Sci Monit. 25: 3583–3590. doi:10.12659/MSM.916483. PMC 6532556 Check |pmc= value (help). PMID 31089068.
  7. Wu HY, Xu WB, Lu LW, Li HH, Tian JS, Li JM; et al. (2018). "Imaging features of spinal atypical teratoid rhabdoid tumors in children". Medicine (Baltimore). 97 (52): e13808. doi:10.1097/MD.0000000000013808. PMC 6314652. PMID 30593171.
  8. Hazelwood JE, Hoeritzauer I, Pronin S, Demetriades AK (2019). "An assessment of patient-reported long-term outcomes following surgery for cauda equina syndrome". Acta Neurochir (Wien). 161 (9): 1887–1894. doi:10.1007/s00701-019-03973-7. PMC 6704093 Check |pmc= value (help). PMID 31263950.

Template:Neuroscience-stub Template:Cerebral palsy and other paralytic syndromes [{Category:Needs patient information]] de:Cauda-equina-Syndrom

Template:WikiDoc Sources