pathology: cauda equina-syndrome

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cauda equina-syndrome

efinition of

Compression of the cauda equina, often together with compression of the conus medullaris (cone-shaped end of the spinal cord S3-S5), is an indication for immediate surgery (within 6 hours of the onset of symptoms (!), irreversible deficits may occur after more than 12 or 24 hours.

ICD G83.4

Cause

  1. Severe dorso-medial discprolapse, usually the disc hernia has existed for a longer period of time with less severe symptoms
  2. Spinal metastases
  3. Pressure atrophy of the nerves after operations such as surgical stiffening
  4. Vertebral fracture

Diagnosis

  1. Neurological tests
  2. MRI
  3. CT
  4. Absence of patellar tendon reflex (L4) and/or absence of Achilles tendon reflex (S1)
  5. Reduced tone of the Auns sphincter (rectal digital examination)
  6. Possible failure or weakening of the patellar tendon reflex or Achilles tendon reflex
  7. Tests and signs: crossed Lasegue

Symptoms

  1. bilateral or alternating sciatica-like pain
  2. Highlight: Breeches anesthesia/hypesthesia (on the inside of the leg), often also asymmetrically pronounced
  3. Highlight: rectal and bladder incontinence/disorders, also – paralysis
  4. Erectile dysfunction
  5. Radicular(nerve root) pain alternating between the sides
  6. Motor deficits in the leg or foot (flaccid paralysis), especially weakness of the foot lifter
  7. Sensory disorders usually occur well after motor disorders
  8. Sweat secretion is maintained
  9. Possible tension pain in the filled bladder, which intensifies when coughing/sneezing

Complications

  1. Pressure atrophy of the nerves
  2. Failure of internal organs

Therapy

  1. OP

DD

  1. severe polyneuropathies