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Cauda equina syndrome may begin with generalised lower back pain and sciatica, but may then progress to cauda equina compression. The point at which a patient develops cauda equina syndrome is determined by the onset of bladder, bowel and rectal dysfunction.
The time of onset of cauda equina syndrome is generally taken to be the time that symptoms of disturbed urinary, rectal and perineal function appear. This might represent reduced bladder, perineal and bowel sensation, and/or the disturbed ability to pass urine or open the bowels.
Thus according to the commonly accepted definition of CES, a patient with a prolapsed intervertebral disc with back pain and sciatica (a pain that runs down the back of the thigh and leg to the foot) does not have cauda equina syndrome until he/she develops urinary and/or rectal symptoms, and/or the symptom of saddle anaesthesia. Saddle anaesthesia indicates the compression of the S3-5 nerve roots which enable sensation in the ‘saddle’ area.
The urinary, rectal and saddle symptoms that indicate the onset of cauda equina syndrome include:
Out of all of these, medical professional should be alert to three main symptoms, known as the ‘red flag symptoms’. The red flags are an indication that CES has started. They are:
The development of the red flag symptoms is an indication for urgent (meaning within hours) MRI scan to determine whether or not there is an acute cauda equina compression.
If doctors fail to spot the red flag symptoms of cauda equina syndrome, resulting in a delay in diagnosis and treatment, there will be grounds for a compensation claim.
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