Complex Presentation of Cauda Equina Syndrome

Cauda equina syndrome is characterised by a complex presentation that can cause confusion among medical practitioners, delaying a diagnosis.

Cauda equina syndrome

Cauda equina syndrome is caused by the compression of the cauda equina nerves, located at the bottom of the spinal cord. Compression can occur in a number of ways, including a central disc prolapse, a spinal tumour or a traumatic accident.

The cauda equina nerves are very fragile and will quickly be damaged when placed under pressure. The cauda equina nerves enable sensation and function in the legs, saddle area (including the buttocks, perineum and genitalia) and bladder. Once damaged, sensation and function in these areas will be reduced and eventually lost.

Presentation of cauda equina syndrome

When spinal nerve compression results in a loss of function and sensation, a person is said to have cauda equina syndrome (CES). This is characterised by a constellation of symptoms that will deteriorate over time. This deterioration may be very rapid (acute cauda equina syndrome), or may develop over a matter of weeks or months (chronic cauda equina syndrome).

The fact that CES can be both abrupt and slow in onset can lead to confusion for medical practitioners.

In chronic CES, a patient is often diagnosed with a generalised condition such as back pain and referred for physiotherapy. Medical practitioners subsequently fail to recognise a patient’s decline and the onset of new symptoms, instead sticking with the original diagnosis.

In acute CES, a patient is often diagnosed with a more minor condition such as a urinary tract infection. Medical practitioners fail to consider the symptoms as a whole, meaning the possibility of nerve compression is not even considered.

Therefore the presentation of cauda equina syndrome can be very varied, not to mention complex. Medical practitioners may fail to understand this, resulting in a missed diagnosis.

Delayed diagnosis

The effects of a missed diagnosis will be troubling. Without decompression surgery, the nerves will continue to suffer harm. In acute cases, the injury will be irreparable within 48 hours. In chronic cases, the injury will be irreparable in a matter of weeks or months. A patient will then face a lifetime of neurological complications, including paralysis and bladder dysfunction.

Medico-legal claims

If medical professionals fail to understand the symptoms of cauda equina syndrome, causing a patient to suffer harm that could otherwise have been avoided with timely treatment, there will be a case of medical negligence. Contact us today for more information.

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