Investigating cauda equina syndrome (summary)

Last revised by Daniel J Bell on 10 Jun 2022
This is a basic article for medical students and other non-radiologists

Cauda equina syndrome (CES) is the compression of nerve roots within the cauda equina and a medical emergency that requires prompt diagnosis, investigation and treatment if the prognosis is to be anything other than bleak 1.

Reference article

This is a summary article; read more in our article on cauda equina syndrome.

  • questions
    • is it really cauda equina syndrome?
      • main diagnostic symptoms are:
        • bladder, bowel and/or sexual dysfunction
        • saddle/perianal parasthesia
      • symptoms develop over hours
      • treatment needs to be prompt to minimize morbidity
    • is there a history of lumbar spine disease?
    • is there a history of cancer?
  • investigations
    • cauda equina syndrome is an emergency
    • urgent imaging is required and must be with MRI
      • what lesion is causing the symptoms
        • disc/vertebral fracture/metastatic deposit
      • the level of the lesion
        • physical examination should help determine this
      • if there is multi-level disease
    • if MRI is not available locally, the patient will need to be transferred
  • making the request
    • features of cauda equina syndrome
    • expected level of disease (from physical examination)
    • onset of symptoms
    • urgency of imaging
  • common pathology
    • disc protrusion
    • vertebral fractures/collapse
    • malignant infiltration
    • disc/vertebral infection

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Cases and figures

  • Case 1: vertebral metastases
    Drag here to reorder.
  • Case 3: spinal fracture with cauda equina syndrome
    Drag here to reorder.
  • Case 2: L5/S1 disc protrusion
    Drag here to reorder.
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