If a patient is suspected of having cauda equina syndrome (CES), he or she should be sent for an urgent MRI scan. If this is not possible, other imaging tests should be carried out.
Recognising CES
If a patient presents with the symptoms characteristic of spinal nerve compression, he or she should be suspected of having a condition called cauda equina syndrome. This is when the cauda equina nerves at the bottom of the spinal cord are compressed by something such as a slipped disc or an inflammation.
Suspicions of cauda equina syndrome should be raised if a patient has the ‘red flag symptoms’, including chronic back pain, perineal numbness and urinary dysfunction. This suspicion should be further heightened if a patient has a recent history of trauma, a slipped disc or a chronic medical condition often associated with CES (such as ankylosing spondylitis).
Tests for cauda equina syndrome
After a thorough physical examination has been performed, a patient should be urgently referred for imaging tests. The study of choice is an MRI scan, as this can help medical professionals evaluate the cause of compression and how best to treat it. If an infection is thought to be present, it may be useful to inject a harmless dye as this will provide further detail.
However, some patients will not be able to have an MRI scan. This will apply to those have a pacemaker, aneurysm clips and metal fragments close to the eyes or organs. If an MRI scan is contraindicated, a CT myelogram should be performed.
Failure to order further tests
Unfortunately not all patients who present with the red flag symptoms of cauda equina syndrome will be sent for urgent imaging tests. Often this is because medical professionals believe a more minor condition is at play and so do not think further tests are needed, or because medical professionals simply do not have an understanding of cauda equina syndrome.
Failing to achieve a diagnosis will be extremely troubling as cauda equina syndrome depends upon early treatment. If the nerves are compressed for too long, permanent damage will be done and treatment will not be effective. If a diagnosis is not achieved because medical professionals fail to refer a patient for an urgent MRI scan – despite the clinical indicators of CES being present – there may be a case of medical negligence.
Cauda equina claims
To claim for cauda equina syndrome, please get in touch with us today. We specialise in cauda equina claims and will be more than happy to assist.