Cauda equina syndrome, a clinical-radiological case

Abstract

Cauda equina syndrome is a surgical emergency of the lumbar spine characterized by a conglomeration of signs and symptoms that includes low back pain with sciatica, dysfunctional disorders of urination, defecation, intestinal peristalsis and sexual function, associated with sensory disorders of the perineum. In order to avoid or diminish remaining functional disorders, the patient must undergo surgery before 24 hours of the start of the clinical manifestations. This study presents the case of a 63-year-old male patient, with a history of low back pain for months and lumbar disc hernias, presently with urinary retention and anal incontinence. On physical examination alteration of the sensitivity of the perineum was found. Magnetic resonance imaging was performed, showing an extruded hernia at the level of the L3-L4 vertebrae that compressed the dural sac and the horse's tail and interruption of the cerebrospinal fluid column. Traumatic or pathological vertebral fracture was ruled out; another hernia contained at disc level L4-L5. Cauda equina syndrome was clinically and radiologically diagnosed. The patient was operated on. He still has the symptoms and functional alterations. He is under rehabilitation treatment.