91 Cauda equina syndrome
Salient features
History
• Ask the patient whether there is pain (usually projected to the perineum and thighs); these are root pain in the dermatomes L2 or L3 or S2 or S3 (whereas pain in L4, L5 or S1 distribution is commonly attributed to disc disease)
• Determine whether there is a history of trauma and ‘neural claudication’ (where the patient develops root pain and leg weakness, usually a foot drop while walking that rapidly recovers with resting)
• Pain in the anterior thigh, wasting of the quadriceps muscle, weakness of the foot invertors (caused by L4 root lesion) and an absent knee jerk
• Obtain history of leukaemia or prostatic carcinoma (primaries for bony metastases).
