How to Diagnose Cauda Equina Syndrome
Watch for leg pain and/or trouble walking.Because Cauda Equina Syndrome (CES) affects the nerves at the bottom of your spinal cord, and because many of these nerves go to your legs, CES in the early stages may present as pain radiating down one or...
Step-by-Step Guide
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Step 1: Watch for leg pain and/or trouble walking.Because Cauda Equina Syndrome (CES) affects the nerves at the bottom of your spinal cord
it is accumulating in your bladder and you cannot urinate), go to the Emergency Room.
If you cannot control your urine (i.e. are leaking urine involuntarily), this is another potential sign of CES.
Similarly, a sudden inability to control your bowels (such as inadvertently passing stool or leaking stool from your rectum) is a possible sign of CES.
All of these warrant prompt medical attention and evaluation. , Seek medical help immediately. ,"If you notice numbness in the "saddle area" (picture the area of your pelvis that would be in contact with a saddle if you were to sit on one), this area it is a "red flag" (worrisome) symptom and you need to see a doctor immediately.
Numbness in the genital ("saddle") area is not normal, and may be a sign of impending (or already present) CES. , You may feel an aching and severe pain in your lower back, which can be debilitating.
This is another red flag symptom and it may vary in intensity or grow slowly over time., You may find that your ankle and knee reflexes are diminished.
You may also experience deteriorating reflexes in the anus and bulbospongiosus muscle, located between the anus and the genitals.,"Oftentimes, CES follows an incident that causes trauma or another problem in the spinal cord.
Things to be aware of that greatly increase your risk of CES include:
A recent infection (it is possible that this may have spread to the spinal cord) Recent back surgery Recent back trauma, such as an accident or other injury A history of cancer (sometimes cancer metastases can spread to the spine leading to compression of the nerve roots) , Time spent waiting or hesitating is precious time lost that could cost you your long-term function and health. , If any of these are abnormal, it may be an indication of potential Cauda Equina Syndrome (CES).
Your doctor may test your mobility and coordination by asking you to walk on your heels and toes.
He or she will examine for pain when you bend forward, backward, and to each side.
Your doctor will check your anal sensation and reflexes, as abnormalities here are key aspects of the diagnosis of CES. , The imaging test will allow the doctor to see your spinal cord, including the nerve roots, and to evaluate what, if anything, may be causing them to be compressed.
Possible sources of spinal cord compression that may be detected on CT or MRI include:
A primary spine tumor or cancer metastases A herniated disc in your spine Bone spurs An infection that has gotten into your spinal cord A fracture of the spinal cord Narrowing of the spinal canal for any reason Inflammatory spinal disorders such as ankylosing spondylitis (inflammatory arthritis) Spinal hemorrhages , This is when contrast material is inserted into the cerebrospinal fluid in your spinal cord, and then an x-ray type image is taken.
The contrast allows clear visualization as to whether there are any abnormalities or displacements in your spinal column.
The myelogram may show herniated discs, bone spurs, or tumors, all of which may be responsible for causing CES. , Your doctor may perform the following tests:
Nerve conduction velocity (NCV) — This test will measure the speed of electrical impulse as it moves through the nerve.
This test can determine if there is nerve damage and can how much.The nerve will be stimulated by an electrode patch attached at one end and the electric impulse is recorded by another patch.Electromyography (EMG) — This test is often done at the same time as an NCV and it measures the electrical activity in your muscles., The surgery needs to be performed within 48 hours of the onset of symptoms, if possible, and the sooner it is done the better.
The surgery will consist of removing whatever material (such as a tumor, or an infection) that is compressing your spinal cord.
The goal is that, by treating the underlying cause (the cause of the spinal cord compression), the tension will be removed from your nerve roots, and you should hopefully be able to regain function. , These may include:
Chronic pain — some people require long-term pain medications to ease ongoing nerve-related pain following CES.
Bladder or bowel dysfunction — some people continue to struggle with bladder and/or bowel control, even after surgical resolution of their CES. (However, the good news here is that bladder and bowel function often improve in the years following surgery; it just may take longer to regain function than other affected areas.) Sexual problems — patients are often advised to see a sex therapist for help if they are struggling to regain sexual function.
Motor problems — problems walking or performing other movement tasks, particularly with your lower limbs. , Needless to say, these are things you want to avoid! Therefore, if in doubt, go to your local Emergency Room for evaluation of your signs and symptoms to ensure that, if you are developing CES, it is treated and resolved as quickly as possible. -
Step 2: and because many of these nerves go to your legs
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Step 3: CES in the early stages may present as pain radiating down one or both legs
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Step 4: and/or trouble moving your legs or walking with the same ease as before.
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Step 5: See your doctor immediately if you are experiencing bladder and/or bowel dysfunction.If you cannot pass urine (i.e.
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Step 6: Notice if you are experience unusual challenges sexually.If you are experiencing a rather sudden and unusual decrease in your sexual sensation
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Step 7: and/or your ability for erection and/or orgasm
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Step 8: this may be a potential sign of CES.
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Step 9: Look out for numbness in the "saddle area.
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Step 10: Pay attention to lower back pain.
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Step 11: Be aware of loss of reflexes.
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Step 12: Consider whether you have had any recent "triggering incidents.
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Step 13: Go to the Emergency Room immediately if you notice any "red flag" symptoms.If you are experiencing any of the symptoms described in this article — leg pain and/or trouble walking
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Step 14: severe back pain or pain or numbness in the saddle area
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Step 15: bladder and/or bowel dysfunction
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Step 16: diminished reflexes in the extremities
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Step 17: sudden changes in sexual function
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Step 18: triggering incidents — it is key that you go straight to the nearest emergency room immediately.
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Step 19: Have your doctor perform a neurological exam.Your doctor will test your reflexes
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Step 20: your ability to move your lower limbs
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Step 21: your strength when he or she applies resistance to your leg muscles
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Step 22: and your sensation when he or she tests your skin with various objects.
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Step 23: Obtain a CT or MRI.If your symptoms suggest that you may have CES
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Step 24: it is key that you receive an imaging test (either a CT or an MRI) as soon as possible.
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Step 25: Receive a myelogram.In addition to standard CT or MRI imaging
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Step 26: you may also receive something called a myelogram.
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Step 27: Receive neurologic nerve testing of the lower extremities.Neurologic tests can help confirm CES and should be undertaken as soon as possible.
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Step 28: Receive emergency surgery.If you have been diagnosed with Cauda Equina Syndrome (CES)
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Step 29: it is key to see a neurosurgeon for surgery immediately.
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Step 30: Prepare for the possible long-term consequences following CES.Depending upon how quickly you received surgical treatment following the onset of symptoms
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Step 31: as well as the degree of neurological (nerve-related) compromise that occurred in your spinal cord
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Step 32: you may end up with residual long-term symptoms or disabilities following CES.
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Step 33: Understand why it is key to seek treatment urgently.If you are experiencing the signs and symptoms of potential CES and fail to receive medical attention immediately
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Step 34: it may result in permanent paralysis of your lower limbs
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Step 35: permanent loss of sexual function and sensation
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Step 36: and/or chronically impaired bladder or bowel function.
Detailed Guide
it is accumulating in your bladder and you cannot urinate), go to the Emergency Room.
If you cannot control your urine (i.e. are leaking urine involuntarily), this is another potential sign of CES.
Similarly, a sudden inability to control your bowels (such as inadvertently passing stool or leaking stool from your rectum) is a possible sign of CES.
All of these warrant prompt medical attention and evaluation. , Seek medical help immediately. ,"If you notice numbness in the "saddle area" (picture the area of your pelvis that would be in contact with a saddle if you were to sit on one), this area it is a "red flag" (worrisome) symptom and you need to see a doctor immediately.
Numbness in the genital ("saddle") area is not normal, and may be a sign of impending (or already present) CES. , You may feel an aching and severe pain in your lower back, which can be debilitating.
This is another red flag symptom and it may vary in intensity or grow slowly over time., You may find that your ankle and knee reflexes are diminished.
You may also experience deteriorating reflexes in the anus and bulbospongiosus muscle, located between the anus and the genitals.,"Oftentimes, CES follows an incident that causes trauma or another problem in the spinal cord.
Things to be aware of that greatly increase your risk of CES include:
A recent infection (it is possible that this may have spread to the spinal cord) Recent back surgery Recent back trauma, such as an accident or other injury A history of cancer (sometimes cancer metastases can spread to the spine leading to compression of the nerve roots) , Time spent waiting or hesitating is precious time lost that could cost you your long-term function and health. , If any of these are abnormal, it may be an indication of potential Cauda Equina Syndrome (CES).
Your doctor may test your mobility and coordination by asking you to walk on your heels and toes.
He or she will examine for pain when you bend forward, backward, and to each side.
Your doctor will check your anal sensation and reflexes, as abnormalities here are key aspects of the diagnosis of CES. , The imaging test will allow the doctor to see your spinal cord, including the nerve roots, and to evaluate what, if anything, may be causing them to be compressed.
Possible sources of spinal cord compression that may be detected on CT or MRI include:
A primary spine tumor or cancer metastases A herniated disc in your spine Bone spurs An infection that has gotten into your spinal cord A fracture of the spinal cord Narrowing of the spinal canal for any reason Inflammatory spinal disorders such as ankylosing spondylitis (inflammatory arthritis) Spinal hemorrhages , This is when contrast material is inserted into the cerebrospinal fluid in your spinal cord, and then an x-ray type image is taken.
The contrast allows clear visualization as to whether there are any abnormalities or displacements in your spinal column.
The myelogram may show herniated discs, bone spurs, or tumors, all of which may be responsible for causing CES. , Your doctor may perform the following tests:
Nerve conduction velocity (NCV) — This test will measure the speed of electrical impulse as it moves through the nerve.
This test can determine if there is nerve damage and can how much.The nerve will be stimulated by an electrode patch attached at one end and the electric impulse is recorded by another patch.Electromyography (EMG) — This test is often done at the same time as an NCV and it measures the electrical activity in your muscles., The surgery needs to be performed within 48 hours of the onset of symptoms, if possible, and the sooner it is done the better.
The surgery will consist of removing whatever material (such as a tumor, or an infection) that is compressing your spinal cord.
The goal is that, by treating the underlying cause (the cause of the spinal cord compression), the tension will be removed from your nerve roots, and you should hopefully be able to regain function. , These may include:
Chronic pain — some people require long-term pain medications to ease ongoing nerve-related pain following CES.
Bladder or bowel dysfunction — some people continue to struggle with bladder and/or bowel control, even after surgical resolution of their CES. (However, the good news here is that bladder and bowel function often improve in the years following surgery; it just may take longer to regain function than other affected areas.) Sexual problems — patients are often advised to see a sex therapist for help if they are struggling to regain sexual function.
Motor problems — problems walking or performing other movement tasks, particularly with your lower limbs. , Needless to say, these are things you want to avoid! Therefore, if in doubt, go to your local Emergency Room for evaluation of your signs and symptoms to ensure that, if you are developing CES, it is treated and resolved as quickly as possible.
About the Author
Jacqueline Webb
Specializes in breaking down complex hobbies topics into simple steps.
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