Assessment of Cauda Equina Syndrome Progression Pattern to Improve Diagnosis

Abstract

The characteristic progressive sensory-motor CESE defects in lower extremities marked CES onset. Instead of waiting for the onset of sphincter function abnormalities, CES should be diagnosed when the CESE symptoms manifest.

Assessment and management of cauda equina syndrome

“…The subjective history is the most important aspect of the examination, particularly early in the presentation of a patient with CES, as the subtle and vague symptoms related to early CES need to be identified using clear and unambiguous methods of communication (Bin et al, 2009, Sun, 2014. However, in the context of severe pain, patients with CES have expressed their difficulty in concentrating on clinical questions, especially when they appear to have no relevance to the pain they are suffering e.g.…”

“…This is compounded by the fact that as the condition progresses, the signs and symptoms do not develop in a recognised pattern (Bin et al,2009). Sun et al (2014) confirm that there is no set chronology of presenting symptoms, creating uncertainty and difficulty with early diagnosis. This is particularly challenging for physiotherapists who often rely on pattern recognition to inform clinical decision making, however knowing that that there is no pattern to look for is paradoxically actually quite useful .…”

“…One of the key issues which has important ramifications for physiotherapy practice, (in particular the initial keep/refer decision), is that early symptoms of CES are often subtle and vague (Bin et al, 2009, Sun et al, 2014. This is compounded by the fact that as the condition progresses, the signs and symptoms do not develop in a recognised pattern (Bin et al,2009).…”

Development of a toolkit for early identification of cauda equina syndrome

“…With this in mind an iterative validation process took place. Current evidence suggests that progressing motor & sensory deficits are important, however, Sun et al (2014) highlights the importance of bladder, bowel and sexual function symptoms in the timely diagnosis of CES. The preservation of these normal functions at the time of diagnosis is directly related to outcome.…”

Szérumbiomarkerek akut lumbalis-lumbosacralis fájdalomban

“…Akut lumbago, lumboischialgia esetén nem diagnózisról, hanem egy tünetről, tünetcsoportról beszélünk, amely mögött számos etiológiai tényező állhat (1. ábra). Az esetek körülbelül 1%-ának hátterében találunk valamilyen súlyos, szisztémás okot, például cauda equina compressiót/metastasist, spinalis epiduralis abscessust, osteomyelitist [3]. A ritka okok között felmerülhet még spondylitis ankylopoetica (Bechterew-kór), osteoarthritis, scoliosis és extraskeletalis okok, mint pancreatitis, nephrolithiasis, pyelonephritis, aorta abdominalis aneurysma, herpes zoster.…”