Cauda Equina Syndrome

54 Male

presented with 

  • 1 week history of low back pain
  • B/L leg pain, worse (L). Reports left leg feels heavy.

7 days ago spoke to GP regarding right leg pain. Reported that the pain had been present for 6 days. GP prescribed codeine 15mg. 

3 days later called 111. Was advised to visit A&E.

A&E Visit

  • Patient has a history of paranoid schizophrenia.
  • Subjective - Bowel and bladder stable, no saddle paresthesia.
  • Exam - tender SIJ, lumbosacral junction, no neurology.
  • Diagnosis - MSK pain, no red flags. Physio referral recommended. 
  • Prescribed Naproxen and Omeprazole

3 days later, spoke with GP. GP prescribed codeine. Advised to walk.

Next day appt in FCP clinic.

  • Patient walked in using a 4 wheel walker. He had borrowed it from his Mother in law.
  • Had a high steppage gait on (L). A week ago was walking fine.
  • preferred to stand
  • complained of back pain and B/L leg pain 

Reported 2 episodes of bowel incontinence. Soiled carpet. Reports no bladder incontinence.

Has long standing diarrhoea


  • unable to walk without walker
  • Poor (L) foot strength - whole foot
  • Also weak (R) foot
  • reduced sensation to light touch in (L) leg - lateral leg
  • absent knee and ankle jerks

Impression: Cauda Equina Syndrome.

Case discussed with GP. given per-rectal exam. anal tone preserved. reduced sensation in saddle anaesthsia.

patient sent to A&E.

Gets an urgent MRI in A&E.

Severe spinal canal stenosis at the L3/L4 level with probable cauda equina compression given the appearances and the clinical history provided.

Undergoes Lumbar decompression + discectomy L3/4 for CES

Post Operative

  • weak (L) foot - partial foot drop
  • B/L calf weakness. Cannot do a calf raise 
  • no bowel or bladder incontinence

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