Cauda Equina Syndrome: The Daily PANCE Blueprint

Home Cauda Equina Syndrome: The Daily PANCE Blueprint

Cauda Equina Syndrome: The Daily PANCE Blueprint

A 60-year-old male presents to the ER with severe lower back pain that started a few weeks ago and has progressively worsened. He now reports bilateral leg weakness, numbness in the perineal region, and difficulty initiating urination. On exam, there is reduced anal tone and decreased sensation in the saddle area. Which of the following is the most likely diagnosis?

A. Lumbar muscle strain
B. Sciatica due to unilateral disc herniation
C. Spinal cord compression from a fracture
D. Cauda equina syndrome
E. Peripheral neuropathy

Answer and topic summary

The answer is D. Cauda equina syndrome

A disk herniation occurs when there is complete extrusion of the nucleus pulposus through a tear in the annulus fibrosis. Discs commonly herniate more posterior/lateral, as the ligament in those regions is thinner. The reason it usually happens is due to gradual, chronic wear and tear (e.g., disk degeneration). Clinical features may include back or neck pain, paresthesia, muscle weakness of atrophy, motor deficits (LMN or UMN signs), and even bladder and bowel issues. Cauda equina syndrome must be ruled out, as this is a surgical emergency. An MRI spine is the best test. Treatment depends, typically conservative management is offered first (physiotherapy, NSAIDs, etc).

View blueprint lesson

Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint Musculoskeletal ⇒ Spinal Disorders ⇒ Cauda equina syndrome

Also covered as part of the Emergency Medicine PAEA EOR topic list

Sign up for the ENTIRE Blueprint Daily Email Series (1000 daily questions. . . and counting! 😀)

Sign Up
X

Have you tried the NEW Smarty PANCE QBANK? It's FREE with EVERY membership purchase 😀!

Meet the new QBank! 👈
X