The Resus Room Cauda Equina Syndrome; Roadside to Resus
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Apr 15, 2024 The podcast explores the challenges of identifying Cauda Equina Syndrome among lower back pain cases, emphasizing the crucial need for timely diagnosis to prevent long-term disabilities and potential litigation. It delves into symptoms, anatomy, diagnostic complexities, and the recently published national Cauda Equina Pathway. The discussion highlights the importance of recognizing red flag symptoms, conducting detailed neurological examinations, and navigating surgical interventions for optimal patient outcomes.
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CES Red Flags
- Suspect CES in patients with back/leg pain and red flag symptoms (urinary issues, saddle anesthesia, sexual dysfunction, bilateral leg weakness).
- Thorough history-taking is crucial, including symptom onset and progression.
Thorough Examination
- Conduct detailed neurological exams, including sensory, motor, and reflex assessments, even if an MRI is planned.
- Establish a baseline to monitor deterioration and consider alternative diagnoses.
Bladder Scan
- Check perianal sensation, as a digital rectal exam (DRE) is a late and unreliable sign.
- Consider a post-void residual bladder scan; over 200 mL suggests a higher likelihood of CES.