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If a patient has the symptoms associated with cauda equina syndrome, a medical practitioner should act immediately. A certain course of events should be initiated, starting with a neurological examination, following with an MRI scan and finally decompression surgery.
There is a set of symptoms which together suggest cauda equina syndrome. These are:
In any patient who has bilateral leg symptoms with a record of altered bladder and bowel function, a detailed assessment of perianal, perineal and saddle sensation should follow. This should include a digital rectal examination. If this cannot be undertaken for any reason, then arrangements need to be made for such an assessment at the local hospital.
Only if the results are found to be normal can a clinician exclude a diagnosis of cauda equina syndrome, for the time being at least. If a patient’s symptoms continue or worsen over the following days/months/years, another examination should be conducted.
Indeed, just because a previous examination has not indicated cauda equina syndrome does not mean that the condition will not develop in the future. It is a progressive syndrome and requires close monitoring.
If there are signs of perineal, perianal, altered saddle sensation or altered anal tone, these should be found during an appropriate examination.
Once these signs are detected, a patient should undergo an MRI scan of the lumbar sacral spine on an emergency basis. This will show whether there is a large prolapsed disc at the L4/5 level, or any other source of compression (such as a tumour).
The patient should then be listed for decompression surgery, again on an emergency basis. This means having surgery on the same day, or early the following morning.
If decompression surgery is performed adequately then, on the balance of probabilities, the patient will be spared all the features of cauda equina syndrome and the complications associated. There may be ongoing episodes of low back pain, but problems such as foot drop, lack of sensation in the lower limbs/perineum/genitals, and bladder/bowel/sexual dysfunction will be avoided.
If medical practitioners do not action the process of diagnosing cauda equina syndrome because the symptoms were not recognised, there could be a case of medical negligence.
To find out if you can claim compensation for cauda equina negligence, please get in touch with us today.
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