scholarly journals Delays in the treatment of cauda equina syndrome due to its variable clinical features in patients presenting to the emergency department

2007 ◽  
Vol 24 (1) ◽  
pp. 33-34 ◽  
Author(s):  
I. Jalloh ◽  
P. Minhas
Keyword(s):  
Emergency Department ◽  
Clinical Features ◽  
Cauda Equina Syndrome ◽  
Cauda Equina

Just the facts: Risk stratifying nontraumatic back pain for Cauda Equina Syndrome in the emergency department

CJEM ◽  
2020 ◽  
Vol 22 (5) ◽  
pp. 652-654
Author(s):  
Zoe Polsky ◽  
Margriet Greidanus ◽  
Anjali Pandya ◽  
W. Bradley Jacobs
Keyword(s):  
Emergency Department ◽  
Back Pain ◽  
Cauda Equina Syndrome ◽  
Bowel Movement ◽  
Chronic Back Pain ◽  
Cauda Equina ◽  
Digital Rectal Examination ◽  
Acute Onset ◽  
Clinical Exam ◽  
History Of

A 43-year-old male, with a history of chronic back pain, presents to the emergency department (ED) with acute onset chronic pain. He states he “tweaked something” and has been debilitated by back pain, radiating down both his legs, for 24 hours. He has not had a bowel movement but denies noticing any “saddle anesthesia.” His clinical exam is limited by pain, and it is difficult to determine if he has objective weakness. His perineal sensation is intact, as is his sensation upon digital rectal examination. The patient has a post-void residual of 250 mL, but you are unsure how to interpret this value. As an emergency physician, when should you suspect, and how should you evaluate cauda equina syndrome?

scholarly journals Expediting the management of cauda equina syndrome in the emergency department through clinical pathway design

2019 ◽  
Vol 8 (4) ◽  
pp. e000597 ◽  
Author(s):  
Kevin G Buell ◽  
Sujan Sivasubramaniyam ◽  
Mark Sykes ◽  
Kamran Zafar ◽  
Lucy Bingham ◽  
...  
Keyword(s):  
Emergency Department ◽  
Clinical Pathway ◽  
Cauda Equina Syndrome ◽  
Primary Outcome ◽  
Cauda Equina ◽  
Neurological Dysfunction ◽  
Time Interval ◽  
Decompression Surgery ◽  
Retrospective Case ◽  
Pdsa Cycle

IntroductionCauda equina syndrome (CES) is a neurosurgical emergency. Early diagnosis with MRI and subsequent surgical decompression surgery can prevent permanent neurological dysfunction. Charing Cross Hospital (CXH) is a tertiary neurosurgical referral centre where in the emergency department (ED), current practice mandated a neurosurgery review prior to requesting MRI.HypothesisIt was hypothesised that a new clinical pathway, with better coordination from the ED, radiology and neurosurgical teams could reduce the time of presentation to diagnosis or exclusion of CES.MethodRetrospective case-note analysis of patients presenting with back pain to CXH ED over a 3-month period was performed. The primary outcome was the time interval between the patient’s arrival to the ED and the MRI preliminary report.ResultsThe baseline primary outcome was recorded at 8 hours and 16 min (n=30). A new clinical pathway was designed empowering ED senior decision makers to order MRIs prior to neurosurgical review. Two Plan-Do-Study-Act (PDSA) cycles were performed, each measured over a 2-month period. The first PDSA cycle was performed after the pathway was initially launched (n=17), while the second PDSA cycle measured the effect of staff education and active promotion of the pathway (n=17). MRI was requested earlier, waiting and reporting time for MRI were reduced. The exclusion or diagnosis of CES was reduced to 5 hours and 54 min in PDSA 1 and 5 hours 17 min in PDSA 2, a 29% and 36% reduction (p=0.048 and p=0.012, respectively).ConclusionThe clinical protocol was a cost-neutral and sustainable intervention that effectively reduced the time taken to diagnose or exclude CES and ED waiting times.

scholarly journals ‘Scan-negative’ cauda equina syndrome: what to do when there is no neurosurgical cause

2021 ◽  
pp. practneurol-2020-002830
Author(s):  
Ingrid Hoeritzauer ◽  
Biba Stanton ◽  
Alan Carson ◽  
Jon Stone
Keyword(s):  
Differential Diagnosis ◽  
Clinical Features ◽  
Acute Pain ◽  
Small Proportion ◽  
Neurological Disorder ◽  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
Common Presentation ◽  
Cauda Equina Compression ◽  
Functional Neurological Disorder

Suspected cauda equina syndrome is a common presentation in emergency departments, but most patients (≥70%) have no cauda equina compression on imaging. As neurologists become more involved with ‘front door’ neurology, referral rates of patients with these symptoms are increasing. A small proportion of patients without structural pathology have other neurological causes: we discuss the differential diagnosis and how to recognise these. New data on the clinical features of patients with ‘scan-negative’ cauda equina syndrome suggest that the symptoms are usually triggered by acute pain (with or without root impingement) causing changes in brain–bladder feedback in vulnerable individuals, exacerbated by medication and anxiety, and commonly presenting with features of functional neurological disorder.

scholarly journals Perirectal Abscess Masquerading as Cauda Equina Syndrome in an Otherwise Healthy 12-Year-Old Child

2014 ◽  
Vol 2014 ◽  
pp. 1-3
Author(s):  
Dylan Dean
Keyword(s):  
Emergency Department ◽  
Back Pain ◽  
Cauda Equina Syndrome ◽  
Pediatric Surgery ◽  
Care Center ◽  
Cauda Equina ◽  
Urgent Care ◽  
Urgent Care Center ◽  
Perirectal Abscess ◽  
Abnormal Gait

A 12-year-old boy was brought to an urgent care center for fever, back pain, and abnormal gait. In addition to back pain, the patient was found to be persistently febrile but also had decreased perianal sensation and bowel incontinence. He was therefore referred to the emergency department where his back pain improved without medication but he was still febrile with bowel incontinence and persistently decreased perianal sensation. An MRI was ordered to evaluate possible cauda equina syndrome and revealed a perirectal abscess. The child ultimately underwent an exam under anesthesia with pediatric surgery and had a drain placed. This case highlights a unique presentation of perirectal abscess masquerading as cauda equina syndrome. A discussion of important considerations in emergency room diagnosis and management is presented.

scholarly journals Tethered Cord Syndrome

2019 ◽  
Vol 3 (3) ◽  
pp. 297-298
Author(s):  
Shawn Catmull ◽  
John Ashurst
Keyword(s):  
Spinal Cord ◽  
Emergency Department ◽  
Emergency Physician ◽  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
Tethered Cord ◽  
Signs And Symptoms ◽  
Conus Medullaris ◽  
Tethered Spinal Cord ◽  
Sensory Dysfunction

Tethered spinal cord syndrome refers to signs and symptoms of motor and sensory dysfunction related to increased tension on the spinal cord due to its abnormal attachment; it has classically been associated with a low-lying conus medullaris. Treatment is primarily surgical and has varying degrees of results. Although rarely diagnosed in the emergency department, the emergency physician must be aware of the disease in patients presenting with signs and symptoms concerning for cauda equina syndrome.

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