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

Exam

• 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