Cauda Equina Syndrome
Cauda equina syndrome (CES) is a rare but serious neurological condition affecting the bundle of nerve roots at the lower end of the spinal cord. The CE provides innervation to the lower limbs, and sphincter,controls the function of the bladder and distal bowel and sensation to the skin around the bottom and back passage
CES occurs when the nerves below the spinal cord are compressed causing compromise to the bladder and bowel. The most common cause of CES is a prolapse of a lumbar disc but other conditions such as metastatic spinal cord compression can also cause CES
Classification :
CESS- Suspected
Patients who do not have CES symptoms but who may go on to develop CES. It is important that patients understand the gravity of the condition and the importance of the time frame to seeking urgent medical attention.
CESI- Incomplete
Patients who present with urinary difficulties with a neurogenic origin, including loss of desire to void, poor stream, needing to strain to empty their bladder, and loss of urinary sensation. These patients could develop CESR and are a medical emergency and should have a surgical opinion urgently.
CESR -Retention
Patients who present with painless urinary retention and overflow incontinence; the bladder is no longer under executive control. An urgent surgical opinion is necessary
CESC-Complete
Patients who have objective loss of the cauda equina function, absent perineal sensation, a loose anus and paralysed bladder and bowel.
Causes :
Cauda Equina Syndrome can have numerous causes, namely:
- Herniated Disc: A herniated disc, especially in the lumbar region, can compress the cauda equina nerve roots, leading to CES.
- Spinal Trauma: Severe injuries to the lower spine, such as fractures or dislocations, can cause CES.
- Tumors: Spinal tumors, whether cancerous or non-cancerous, can exert pressure on the cauda equina nerves.
- Infections: In rare cases, infections like abscesses in the lumbar spine can lead to the development of Cauda Equina Syndrome.
- Congenital Conditions: Some individuals are born with anatomical abnormalities that predispose them to CES.
Signs And Symptoms :
- Bilateral neurogenic sciatica: Pain associated with the back and/or unilateral/bilateral leg symptoms may be present.
- Reduced perineal sensation: Sensation loss in the perineum and saddle region is the most commonly reported symptom.
- Altered bladder function leading to painless retention: Bladder dysfunction is the most commonly reported symptom and can range from increased frequency, difficulty in micturition, change in stream, incontinence, and retention.
- Loss of anal tone: Loss or reduced anal tone may be evident if a patient reports bowel dysfunction. Bowel dysfunction may include incontinence, inability to control motions, inability to feel when the bowel is full, and consequently overflow.
- Loss of sexual function: Sexual dysfunction is not widely mentioned in the literature but is an important aspect that should be discussed with patients.
Treatments :
- Patra pindsweda
- Kati Basti
- Basti (Given in Kala Basti schedule in the ratio of 3:1 of Matra basti to Niruha Basti)