Cauda equina syndrome is a medical emergency that needs immediate diagnosis and treatment. The faster the treatment (through surgical decompression of the spinal cord), the greater the chances of a full recovery. To be able to recognize it, it is necessary to identify its signs, symptoms and immediately go to the emergency room; Your doctor performs a series of tests and evaluations to confirm the diagnosis, identify causes, and get you treated as soon as possible.
Steps
Part 1 of 3: Recognizing Signs and Symptoms
Step 1. Pay attention to leg pain and / or walking problems
As this syndrome affects the nerves at the base of the spinal cord and since many of these reach the legs, in the early stages of the disease the patient complains of pain radiating to one or both of the lower limbs and / or difficulty moving or inability to walk. with the usual fluency.
Step 2. See your doctor right away if you have bladder and / or bowel dysfunction
If you can't urinate (pee builds up in your bladder but you can't get rid of it), go to the emergency room. if you can't control urination (incontinence), know that this is another potential symptom of the syndrome. Similarly, a sudden inability to manage bowel movements (fecal incontinence or loose stools from the rectum) can be related to cauda equina syndrome. All these ailments warrant a prompt medical examination and evaluation.
Step 3. Pay attention to strange difficulties with sexual function
If you suffer from an unexpected decrease in sexual sensitivity, inability to have an erection or orgasm, the syndrome could be the culprit; again, see a doctor without delay.
Step 4. Check for a loss of sensation in the buttocks and inner thighs
Take into consideration the part of the body that comes into contact with the saddle when riding. If you experience numbness in this area, know that this is a very clear "warning sign" and you need to go to the emergency room right away. Loss of sensation in the genital area is not normal at all and could be a sign of a developing or existing syndrome.
Step 5. Don't neglect lower back pain
You may experience severe pain or pain in your lower back which can even be debilitating. Again, this is a "wake-up call"; the pain may slowly increase over time or vary in intensity.
Step 6. Be aware of the loss of reflexes
You may find that your knee or ankle reflexes have decreased, you may notice the same symptom in the anus or bulbocavernosus muscles found in the perineum.
Step 7. Determine if you have recently had any accidents that may have triggered cauda equina syndrome
Often, the condition follows trauma or another spinal cord problem. Here are some factors to look out for that can increase the chances of the syndrome:
- A recent infection (which may have spread to the spinal cord);
- Recently undergone back surgery;
- Trauma to the back, such as an accident or other injury
- Having had cancer in the past (sometimes metastases reach the spinal cord by compressing the nerve roots).
Step 8. Go to the emergency room immediately if you complain of symptoms that are "red flags"
If you experience any of the disorders described above - leg pain and / or difficulty walking, severe low back pain, pain or numbness in the buttocks and genital area, faecal or urinary incontinence problems, decreased reflexes in the lower extremities, sudden changes in sexual function - or you've had an accident, the best thing to do is go to the hospital right away. Time wasted waiting is actually valuable time that could cost you your health and compromise certain skills.
Part 2 of 3: Undergo Visits and Assessments
Step 1. Undergo a neurological examination
The doctor checks the tactile sensitivity, reflexes, the ability to move the limbs and the strength of the leg muscles by applying resistance to them; if you notice any abnormalities, it could be cauda equina syndrome.
- Your doctor checks your motility and coordination by asking you to walk on your heels and toes.
- He may test you to see if you feel pain when you lean forward, backward, and to the sides.
- It also checks for anal sensitivity and reflexes, as abnormalities in this area are important factors in making the diagnosis of the syndrome.
Step 2. Get a computed tomography or MRI scan
If the symptoms suggest this pathology, it is essential to have an imaging test (MRI or computed tomography) as soon as possible. This examination allows the doctor to view the spinal cord, including nerve roots, and to evaluate the presence of something that is compressing it. The various causes of spinal compression are:
- Primary spine cancer or metastases of other cancers;
- Slipped disc;
- Bone spurs;
- Infection that has reached the spinal cord
- Spinal cord fracture;
- Narrowing of the spinal canal due to several reasons;
- Spinal inflammatory disorders, such as ankylosing spondylitis (inflammatory arthritis);
- Spinal hemorrhages.
Step 3. Get myelography
In addition to a normal computed tomography or magnetic resonance scan, you can also do this exam, during which you insert contrast fluid into the cerebrospinal fluid before taking a particular type of x-ray.
- The contrast fluid allows you to clearly visualize any abnormalities or displacements of the spinal cord.
- Myelography reveals herniated discs, bone spurs, or tumors that could be causing the syndrome.
Step 4. Do a lower extremity nerve conduction study
This series of tests helps confirm the diagnosis and should be done as soon as possible. The doctor can perform:
- Test of the conduction speed of the nerve impulse: measures the speed with which the electrical impulse travels the nerve, allowing to understand if the latter is damaged and with what severity. The nerve is stimulated with an adhesive electrode at one end and the pulse is recorded by a second electrode at the other end.
- Electromyography: it is usually conducted in conjunction with the first test and measures the electrical activity present in the muscles.
Part 3 of 3: Treatment
Step 1. Undergo surgery
If you have been diagnosed with cauda equina syndrome, it is essential that the neurosurgeon operates on you as soon as possible. The procedure should be done within 48 hours of the onset of symptoms, if possible; the sooner it is done, the better.
- The surgery involves removing the material that is causing the compression (such as a tumor or infection).
- The goal is to eliminate pressure from the nerve roots by treating the underlying cause (which is crushing the spinal cord), with the hope of being able to regain functionality.
Step 2. Prepare for the long-term consequences of the syndrome
Depending on the timeliness of the surgery and the severity of the neurological damage you have suffered, you may suffer from permanent ailments and disabilities, including:
- Chronic pain: some people have to take analgesic medications for a long time to manage ongoing suffering;
- Bowel and bladder dysfunction: some patients continue to have faecal incontinence or urination problems even after surgery; however, it seems that fortunately this situation can improve over the years, it just takes more time to recover to normality;
- Sexual Problems: It is often advised to consult a sex counselor or therapist to restore this function;
- Movement problems: difficulty walking or performing movements with the legs.
Step 3. Understand why prompt and urgent action is essential
If you complain of the signs and symptoms of the syndrome and do not go to a doctor immediately, you could be paralyzed forever in the lower part of the body, permanently lose sexual functions and sensitivity, as well as bowel and bladder ones. a prospect you obviously want to avoid! So, if you have any doubts, don't hesitate to go to the hospital for a symptom assessment and, if you are developing the syndrome, to undergo treatment as quickly as possible.
