When Should A GP Suspect Cauda Equina Syndrome?

Cauda equina syndrome is frequently diagnosed too late to be able to provide the patient with a good recovery. This can be the cause of a significant compensation claim. What should a GP really be looking out for?

Early diagnosis problems

Early symptoms of cauda equina syndrome can be confused with other conditions and, since the condition is fairly rare, GPs frequently do not consider that there might be another cause of their patient’s pain.

The early symptoms of cauda equina syndrome are likely to be lower back pain and pain associated with tingling or numbness in one of the legs.

This is likely to be diagnosed as sciatica, caused by compression of the sciatic nerve in the lower back.

It is possible, however, that it is, in fact, the cauda equina nerves which are being compressed and the patient is exhibiting the early symptoms of cauda equina syndrome, a life-changing and severely debilitating condition.

Suspected cauda equina syndrome

If the patient’s symptoms extend beyond those in one leg, the GP might have cause to consider cauda equina syndrome.

If the patient is starting to develop symptoms in both legs rather than one, the problem may not be caused by the sciatic nerve.

If, for instance, they are starting to experience weakness in both legs, or numbness and tingling, or if there are signs of muscle and reflex weakness in the feet, the GP might need to consider an alternative diagnosis.

The patient does not necessarily have cauda equina syndrome but, if there are no other symptoms present, the GP ought to advise the patient of the red flag symptoms to look out for.

Symptoms indicating incomplete cauda equina syndrome

If the patient is exhibiting some of the following additional symptoms, they may well be developing the condition and could require an emergency MRI:

• Urinary difficulties such as poor flow, having to strain to urinate, difficulty emptying the bladder, loss of sensation when urinating
• Altered sensation or loss of sensation in the ‘saddle’ area between the legs and around the anus

Failure to diagnose

A failure to refer a patient for an emergency MRI when they are exhibiting these symptoms may well mean that the patient does not receive surgery until their symptoms have deteriorated further and the chance of recovery is diminished.

Where the GP did not act urgently on the patient’s symptoms of cauda equina syndrome leading to a poor, long-term outcome, it may be appropriate to consider making a claim for compensation.

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