Cauda equina
•Download as ODP, PDF•
4 likes•1,756 views
This document discusses Cauda Equina Syndrome and the importance of combining intuitive and analytical thinking in clinical decision making. It describes a scenario where a paramedic initially thought an elderly patient had experienced a mechanical fall, but through further assessment realized the patient could be experiencing Cauda Equina Syndrome based on symptoms of back pain, sciatica, and loss of sensation. The document then provides details on the anatomy of the Cauda Equina, causes and symptoms of Cauda Equina Syndrome, and importance of rapid transport and treatment.
Report
Share
Report
Share
Recommended
Cauda equina syndrome
Presented an in-service on the pathophysiology and differential diagnosis of cauda equina syndrome to Arcadia University's 2nd year Doctor of Physical Therapy students.
Cauda equina syndrome
A 38-year-old woman presents with back pain radiating down her left leg and difficulty passing urine. On examination, she has weakness of left plantar flexion and hip extension with absent left ankle reflex. Pinprick sensation is preserved in the lower limbs but absent in the perineum. An MRI shows a large disc prolapse at L5/S1 compressing the cauda equina. Cauda equina syndrome is diagnosed and emergency surgery is required to decompress the nerves, as symptoms have been present for less than 24 hours. Post-operatively, symptoms improve but leg pain recurs, requiring MRI to check for residual compression.
Cauda Equina Syndrome
Cauda equina syndrome is a surgical emergency that occurs when the spinal canal is significantly narrowed, compressing the spinal cord and nerves below. It causes a variety of symptoms like leg and bladder problems. Early diagnosis and treatment are crucial, as waiting over 24 hours or symptoms worsening requires immediate surgery to decompress the spine. Prognosis depends on the severity and extent of symptoms, with bilateral leg pain or complete groin numbness indicating a poorer prognosis.
Cauda Equina syndrome
This document discusses Cauda Equina Syndrome, a medical condition where the bundle of nerves (cauda equina) in the lower back is compressed, putting pressure on the nerves that control bowel and bladder function. It provides details on a patient case, symptoms like pain, saddle anesthesia, and bladder/bowel dysfunction. Research findings are presented on outcomes depending on surgery timing (better outcomes for patients treated within 48 hours) and severity of bladder/bowel dysfunction. Categories of cauda equina syndrome severity and their relationship to surgery outcomes are described from a 2016 literature review.
Cauda Equina Syndrome
Cauda Equina Syndrome is a condition involving the bundle of nerves originating from the lower end of the spinal cord. It can result from central disc herniations, spinal tumors, trauma, or other causes. Patients may experience LMN signs, saddle anesthesia, gait ataxia, and sexual/bladder/bowel dysfunction. MRI is used for diagnosis. Treatment requires immediate neurosurgical consultation and decompression, as delays can lead to permanent deficits.
Spine Lecture cauda equina syndrome 2019 sept
Cauda Equina Syndrome is a medical emergency caused by compression of the cauda equina nerve roots in the lumbar spine. Symptoms include low back pain, sciatica, saddle anesthesia, and bowel/bladder dysfunction. Delays in surgery of greater than 48 hours are associated with worse functional outcomes. Physical exam alone is a poor predictor, but pre- and post-void bladder scans and perianal sensation testing provide better sensitivity and specificity for diagnosing Cauda Equina Syndrome. Early identification and emergency MRI are critical to prevent permanent nerve damage from prolonged compression.
Cauda Equina
A 55-year-old female presented with worsening low back pain for 3 weeks along with difficulty urinating and intermittent lower extremity numbness. On physical exam, she had mild lumbar tenderness, perineal anesthesia, decreased rectal tone, and intact motor/sensation and reflexes. She is exhibiting signs and symptoms consistent with cauda equina syndrome, which requires immediate neurosurgery consultation and hospital admission for possible urgent surgical decompression and close neurological monitoring including Foley catheterization.
Elderly male with Flaccid paraparesis diagnosed as Cauda Equina Syndrome due ...
Elderly male with Flaccid paraparesis diagnosed as Cauda Equina Syndrome due ...Dr. Md. Rashedul Islam
A 66-year-old diabetic man presented with progressive difficulty walking and low back pain radiating to his left leg over 1 month. Examination found wasting and weakness in his lower limbs, absent reflexes, and reduced sensation. Imaging showed a fractured L5 vertebra and lytic lesions. Biopsies indicated multiple myeloma, causing cauda equina syndrome through vertebral collapse. He was diagnosed with multiple myeloma and diabetes, treated with steroids, physiotherapy and hematology referral.Recommended
Cauda equina syndrome
Presented an in-service on the pathophysiology and differential diagnosis of cauda equina syndrome to Arcadia University's 2nd year Doctor of Physical Therapy students.
Cauda equina syndrome
A 38-year-old woman presents with back pain radiating down her left leg and difficulty passing urine. On examination, she has weakness of left plantar flexion and hip extension with absent left ankle reflex. Pinprick sensation is preserved in the lower limbs but absent in the perineum. An MRI shows a large disc prolapse at L5/S1 compressing the cauda equina. Cauda equina syndrome is diagnosed and emergency surgery is required to decompress the nerves, as symptoms have been present for less than 24 hours. Post-operatively, symptoms improve but leg pain recurs, requiring MRI to check for residual compression.
Cauda Equina Syndrome
Cauda equina syndrome is a surgical emergency that occurs when the spinal canal is significantly narrowed, compressing the spinal cord and nerves below. It causes a variety of symptoms like leg and bladder problems. Early diagnosis and treatment are crucial, as waiting over 24 hours or symptoms worsening requires immediate surgery to decompress the spine. Prognosis depends on the severity and extent of symptoms, with bilateral leg pain or complete groin numbness indicating a poorer prognosis.
Cauda Equina syndrome
This document discusses Cauda Equina Syndrome, a medical condition where the bundle of nerves (cauda equina) in the lower back is compressed, putting pressure on the nerves that control bowel and bladder function. It provides details on a patient case, symptoms like pain, saddle anesthesia, and bladder/bowel dysfunction. Research findings are presented on outcomes depending on surgery timing (better outcomes for patients treated within 48 hours) and severity of bladder/bowel dysfunction. Categories of cauda equina syndrome severity and their relationship to surgery outcomes are described from a 2016 literature review.
Cauda Equina Syndrome
Cauda Equina Syndrome is a condition involving the bundle of nerves originating from the lower end of the spinal cord. It can result from central disc herniations, spinal tumors, trauma, or other causes. Patients may experience LMN signs, saddle anesthesia, gait ataxia, and sexual/bladder/bowel dysfunction. MRI is used for diagnosis. Treatment requires immediate neurosurgical consultation and decompression, as delays can lead to permanent deficits.
Spine Lecture cauda equina syndrome 2019 sept
Cauda Equina Syndrome is a medical emergency caused by compression of the cauda equina nerve roots in the lumbar spine. Symptoms include low back pain, sciatica, saddle anesthesia, and bowel/bladder dysfunction. Delays in surgery of greater than 48 hours are associated with worse functional outcomes. Physical exam alone is a poor predictor, but pre- and post-void bladder scans and perianal sensation testing provide better sensitivity and specificity for diagnosing Cauda Equina Syndrome. Early identification and emergency MRI are critical to prevent permanent nerve damage from prolonged compression.
Cauda Equina
A 55-year-old female presented with worsening low back pain for 3 weeks along with difficulty urinating and intermittent lower extremity numbness. On physical exam, she had mild lumbar tenderness, perineal anesthesia, decreased rectal tone, and intact motor/sensation and reflexes. She is exhibiting signs and symptoms consistent with cauda equina syndrome, which requires immediate neurosurgery consultation and hospital admission for possible urgent surgical decompression and close neurological monitoring including Foley catheterization.
Elderly male with Flaccid paraparesis diagnosed as Cauda Equina Syndrome due ...
Elderly male with Flaccid paraparesis diagnosed as Cauda Equina Syndrome due ...Dr. Md. Rashedul Islam
A 66-year-old diabetic man presented with progressive difficulty walking and low back pain radiating to his left leg over 1 month. Examination found wasting and weakness in his lower limbs, absent reflexes, and reduced sensation. Imaging showed a fractured L5 vertebra and lytic lesions. Biopsies indicated multiple myeloma, causing cauda equina syndrome through vertebral collapse. He was diagnosed with multiple myeloma and diabetes, treated with steroids, physiotherapy and hematology referral.Cauda equina syndrome - Dafydd Loughran
This document discusses Cauda Equina Syndrome (CES) and other spinal disorders. It defines CES and describes its typical presentation, including severe lower back pain, sciatica, saddle numbness, and bladder/bowel dysfunction. CES requires urgent MRI and possible surgical decompression within 24 hours for best outcomes. Other topics covered include spinal anatomy, types of disc herniations, and patterns of spinal cord injury such as complete cord injury and Brown-Sequard syndrome.
Cauda equina syndrome bowel dysfunction
Cauda equina syndrome (CSE) is classically featured by the compression of the distal lumbar, sacral and coccygeal nerve roots at the deep end of the conus medullaris at the L1 and L2 vertebral level. Although this disease has a low incidence in the population, ranging from 1:33,000 to 1:100,000 inhabitants, its sequela still generate extreme public healthcare costs (Angus et al., 2015).
The clinical signs and peculiar features of the pathology are: severe back pain, often accompanied by sciatica; saddle(joint)anesthesia; sphincter and sexual dysfunction; and lower limb weakness (Balasubramanian et al.,2010).The presence of all these signs simultaneously is not typically required for diagnosis(Cook et al.,2007). The clinical history and the neurological examination pave to the need for diagnostic confirmation through complementary exams such as computed tomography (CT) and the gold standard, magnetic resonance imaging (MRI)
CAUDA EQUINA VS CONUS MEDULLARIS SYNDROME
- The conus medullaris syndrome involves compression of the lower end of the spinal cord known as the conus medullaris, located around the L1-L2 vertebrae. This can result in saddle anesthesia, absent bulbocavernous and anal reflexes, and both upper and lower motor neuron signs and symptoms below the level of compression.
- The cauda equina syndrome involves compression of the bundle of spinal nerve roots in the lower back called the cauda equina. It can cause radicular pain, urinary retention, and asymmetric sensory loss. MRI is key for diagnosis and treatment involves decompression through procedures like discectomy, laminectomy, or corpectomy.
-
Spinal stenosis
Spinal stenosis is a degenrative spine disorder in which the AP and transverse diameter are decreased causing neural compression and symptoms of chronic & acute nerve compression
The Challenge Of Acute Back Pain
The document discusses the challenges of diagnosing and treating acute back pain in emergency departments. It outlines key considerations for determining whether a patient's back pain could be caused by a serious underlying condition versus a simple mechanical issue. Imaging tests are recommended selectively based on risk factors present, with conservative treatment usually first for mechanical back pain. "Cannot miss" conditions like spinal infections, tumors, or abdominal aortic aneurysms require prompt diagnosis and treatment.
When Not To Thrombolyse - A Case Series
This presentation describes a few cases of stroke that presented within golden period but could not be thrombolysed. It is a case based discussion on when not to thrombolyse
Idiopathic intracranial hypertension
A 14-year-old girl presented with a 1-month history of headaches and 4 days of transient visual obscurations. She had a history of meningitis and oral steroid use. Idiopathic intracranial hypertension (IIH) is a disorder of unknown cause characterized by elevated intracranial pressure without a tumor. Common symptoms include headaches, vision loss, and papilledema. Treatment involves weight loss, medications like acetazolamide to reduce intracranial pressure, and CSF diversion procedures if necessary to prevent vision loss.
150 Pseudotumor cerebri
This document discusses pseudotumor cerebri (PTC), also known as idiopathic intracranial hypertension. PTC is characterized by increased intracranial pressure without a tumor or other mass. It most commonly affects obese young women. Symptoms include headache, vision changes like transient visual obscurations, and papilledema. Treatment involves weight loss, medication like acetazolamide, repeated lumbar punctures, and sometimes surgical procedures like shunt placement or optic nerve sheath fenestration if other treatments fail to prevent vision loss. Prognosis depends on factors like severity of papilledema and rate of visual decline.
Spinal Cord Injury (SCI)
A spinal cord injury (SCI) is damage to the spinal cord that causes temporary or permanent changes in its function.
Cauda equina syndrome
Cauda Equina Syndrome (CES) involves impairment of bladder, bowel or sexual function and perianal or saddle numbness due to dysfunction of the sacral and lumbar nerve roots within the vertebral canal. The most common causes are disc herniation, tumors, infection, and spinal stenosis. Early diagnosis through examination of symptoms and MRI imaging is important, as early surgical decompression within 24 hours of onset improves patient outcomes and reduces long-term disability. Treatment involves relieving pressure on the nerves through wide laminectomy and decompression surgery. Rehabilitation focuses on mobilization while limiting exertion to allow scar tissue to form.
Spine Conditions
Back pain is the leading cause of disability worldwide and 80% of Americans will experience back pain at some point in their lives. Scoliosis is an abnormal sideways curvature of the spine that is usually treated with braces for mild cases or surgery for severe cases. A herniated disc occurs when the jelly-like center of a spinal disc squeezes out through a tear in the outer ring, which can be caused by age, injury, or heavy lifting. Cauda equina syndrome is a serious condition involving compression of the bundle of nerves in the lower spine and requires emergency surgery to prevent permanent nerve damage.
Radiological assessment – Part 2
Presented by:
Dr David Lisle — Radiologist
Event:
Bundaberg GP & Allied Health Education Day - 2015
Lbp with radiculopathy
This document provides guidelines for treating radiculopathy and back pain. It discusses:
- Common causes of back pain including ligament/muscle strains and spinal issues
- Nonsurgical and pharmacological treatment options for acute, subacute, and chronic back pain including exercise, NSAIDs, muscle relaxants, and opioids
- Surgical indications and procedures for severe or persistent back pain such as spinal fusion, disc replacement, and microdiscectomy
- Approaches to acute radiculopathy including imaging, glucocorticoids, opioids, and exercise-based rehabilitation
Appropriate imaging for low back pain
1) The document discusses appropriate imaging for back pain, describing different imaging modalities like X-rays, CT scans, bone scans, and MRI.
2) It categorizes back pain into 3 groups: nonspecific low back pain, back pain associated with radiculopathy, and back pain associated with a specific cause needing prompt evaluation.
3) Guidelines recommend triaging patients into these 3 categories and only imaging those with red flags, severe/progressive neurological symptoms, or if considering surgery/injections. Imaging is not recommended for nonspecific back pain.
Spinal cord injuries and diseases
Spinal cord injuries and diseases can cause various neurological deficits depending on the level and nature of the injury or disease. Some key points:
1. Spinal cord injuries result in changes to motor, sensory or autonomic function that can be temporary or permanent. Common causes include trauma, compression, and ischemia.
2. Different levels of injury cause specific deficits - cervical injuries may cause quadriplegia while thoracic injuries cause leg weakness and bladder/bowel issues.
3. Specific patterns include Brown-Sequard syndrome where one side is weaker and the other has loss of sensation, and central cord syndrome affecting the arms more than legs.
4. The anatomy and pathways of the spinal
Lumbosacral radiculopathy
Low back pain is one of the most common musculoskeletal complaints encountered in clinical practice. It is the leading cause of disability in the developed world and accounts for billions of dollars in healthcare costs annually. Although epidemiological studies vary, the incidence of low back pain is estimated to be anywhere between 5% to more than 30% with a lifetime prevalence of 60% to 90%. Most occurrences of low back pain are self-limited and resolve without intervention. Approximately 50% of cases will resolve within one to two weeks. 90% of cases will resolve in six to 12 weeks. The differential for low back pain is broad, and amongst other diagnoses, should include lumbosacral radiculopathy. Lumbosacral radiculopathy is a term used to describe a pain syndrome caused by compression or irritation of nerve roots in the lower back. It can be caused by lumbar disc herniation, degeneration of the spinal vertebra, and narrowing of the foramen from which the nerves exit the spinal canal. Symptoms include low back pain that radiates into the lower extremities in a dermatomal pattern. Other accompanying symptoms can include numbness, weakness, and loss of reflexes, although the absence of these symptoms does not exclude a diagnosis of lumbosacral radiculopathy.
Spinal cord injuries
Spinal cord injuries complete topic about it and how to make good rehabilitation for the patient with spinal cord injuries .
wish it help people
my pleasure :)
Mostafa shakshak
Neck and back pain
This document discusses neck pain, its causes, evaluation, and treatment. It notes that neck pain is the fourth leading cause of disability in the US. Causes include trauma, degeneration, inflammation, infection, infiltration, and compression. Neck pain is categorized as uncomplicated, radiculopathy, or myelopathy. Evaluation involves history, physical exam including tests like Spurling's sign, and imaging like x-rays or MRI. Common conditions are mechanical disorders, disc herniation, spondylosis, stenosis, cancer, and myofascial syndrome. Treatment depends on severity but may include conservative options like physiotherapy, medications, collar, or referral to specialist. Uncomplicated neck pain is usually treated with
Spinal cord injuries
- Spinal cord injuries occur most often in males aged 16-30 and result from motor vehicle accidents, violence, falls, or sports.
- Medical management includes immobilizing the spine, administering steroids to reduce swelling, and surgery to decompress the spinal cord if needed.
- Nursing management focuses on respiratory care if needed, skin integrity, bowel and bladder care, pain management, and preventing complications like infection, blood clots, and autonomic dysreflexia.
Spinal cord injury
This document provides information on spinal cord anatomy, neuroanatomy, blood supply, and injury. It describes the following:
- The spinal cord extends from the foramen magnum to the L1 vertebra and is made up of 31 spinal nerve pairs that innervate different parts of the body.
- Spinal cord injury can be complete or incomplete and results from primary mechanical damage or secondary cellular processes. Injuries are classified using scales like ASIA.
- Clinical features depend on the level and severity of injury and may include motor/sensory deficits, respiratory issues, or autonomic dysfunction. Proper history and exam are needed to evaluate patients.
- Epidemiology shows injuries
Cauda equina syndrome
This document summarizes the experience with cauda equina syndrome (CES) at AIIMS hospital in India. It reports that CES accounted for 2.76% of spinal surgeries in their series. While the duration of symptoms did not correlate with recovery outcomes, early diagnosis and surgery was recommended to stop the progression of incomplete CES lesions to complete lesions. The results showed that after surgery, 67% of patients had normal sensory function recovered, 100% of bladder functions improved or remained mild, and 45% had normal motor function recovery.
Conus medullaris and cauda equina syndromes
Here are the answers to your questions:
1. Two etiologies of conus medullaris and/or cauda equina syndrome are tumor and disc herniation.
2. The most common location for the end of the spinal cord in the adult human is the L1-L2 vertebral level, known as the conus medullaris.
More Related Content
What's hot
Cauda equina syndrome - Dafydd Loughran
This document discusses Cauda Equina Syndrome (CES) and other spinal disorders. It defines CES and describes its typical presentation, including severe lower back pain, sciatica, saddle numbness, and bladder/bowel dysfunction. CES requires urgent MRI and possible surgical decompression within 24 hours for best outcomes. Other topics covered include spinal anatomy, types of disc herniations, and patterns of spinal cord injury such as complete cord injury and Brown-Sequard syndrome.
Cauda equina syndrome bowel dysfunction
Cauda equina syndrome (CSE) is classically featured by the compression of the distal lumbar, sacral and coccygeal nerve roots at the deep end of the conus medullaris at the L1 and L2 vertebral level. Although this disease has a low incidence in the population, ranging from 1:33,000 to 1:100,000 inhabitants, its sequela still generate extreme public healthcare costs (Angus et al., 2015).
The clinical signs and peculiar features of the pathology are: severe back pain, often accompanied by sciatica; saddle(joint)anesthesia; sphincter and sexual dysfunction; and lower limb weakness (Balasubramanian et al.,2010).The presence of all these signs simultaneously is not typically required for diagnosis(Cook et al.,2007). The clinical history and the neurological examination pave to the need for diagnostic confirmation through complementary exams such as computed tomography (CT) and the gold standard, magnetic resonance imaging (MRI)
CAUDA EQUINA VS CONUS MEDULLARIS SYNDROME
- The conus medullaris syndrome involves compression of the lower end of the spinal cord known as the conus medullaris, located around the L1-L2 vertebrae. This can result in saddle anesthesia, absent bulbocavernous and anal reflexes, and both upper and lower motor neuron signs and symptoms below the level of compression.
- The cauda equina syndrome involves compression of the bundle of spinal nerve roots in the lower back called the cauda equina. It can cause radicular pain, urinary retention, and asymmetric sensory loss. MRI is key for diagnosis and treatment involves decompression through procedures like discectomy, laminectomy, or corpectomy.
-
Spinal stenosis
Spinal stenosis is a degenrative spine disorder in which the AP and transverse diameter are decreased causing neural compression and symptoms of chronic & acute nerve compression
The Challenge Of Acute Back Pain
The document discusses the challenges of diagnosing and treating acute back pain in emergency departments. It outlines key considerations for determining whether a patient's back pain could be caused by a serious underlying condition versus a simple mechanical issue. Imaging tests are recommended selectively based on risk factors present, with conservative treatment usually first for mechanical back pain. "Cannot miss" conditions like spinal infections, tumors, or abdominal aortic aneurysms require prompt diagnosis and treatment.
When Not To Thrombolyse - A Case Series
This presentation describes a few cases of stroke that presented within golden period but could not be thrombolysed. It is a case based discussion on when not to thrombolyse
Idiopathic intracranial hypertension
A 14-year-old girl presented with a 1-month history of headaches and 4 days of transient visual obscurations. She had a history of meningitis and oral steroid use. Idiopathic intracranial hypertension (IIH) is a disorder of unknown cause characterized by elevated intracranial pressure without a tumor. Common symptoms include headaches, vision loss, and papilledema. Treatment involves weight loss, medications like acetazolamide to reduce intracranial pressure, and CSF diversion procedures if necessary to prevent vision loss.
150 Pseudotumor cerebri
This document discusses pseudotumor cerebri (PTC), also known as idiopathic intracranial hypertension. PTC is characterized by increased intracranial pressure without a tumor or other mass. It most commonly affects obese young women. Symptoms include headache, vision changes like transient visual obscurations, and papilledema. Treatment involves weight loss, medication like acetazolamide, repeated lumbar punctures, and sometimes surgical procedures like shunt placement or optic nerve sheath fenestration if other treatments fail to prevent vision loss. Prognosis depends on factors like severity of papilledema and rate of visual decline.
Spinal Cord Injury (SCI)
A spinal cord injury (SCI) is damage to the spinal cord that causes temporary or permanent changes in its function.
Cauda equina syndrome
Cauda Equina Syndrome (CES) involves impairment of bladder, bowel or sexual function and perianal or saddle numbness due to dysfunction of the sacral and lumbar nerve roots within the vertebral canal. The most common causes are disc herniation, tumors, infection, and spinal stenosis. Early diagnosis through examination of symptoms and MRI imaging is important, as early surgical decompression within 24 hours of onset improves patient outcomes and reduces long-term disability. Treatment involves relieving pressure on the nerves through wide laminectomy and decompression surgery. Rehabilitation focuses on mobilization while limiting exertion to allow scar tissue to form.
Spine Conditions
Back pain is the leading cause of disability worldwide and 80% of Americans will experience back pain at some point in their lives. Scoliosis is an abnormal sideways curvature of the spine that is usually treated with braces for mild cases or surgery for severe cases. A herniated disc occurs when the jelly-like center of a spinal disc squeezes out through a tear in the outer ring, which can be caused by age, injury, or heavy lifting. Cauda equina syndrome is a serious condition involving compression of the bundle of nerves in the lower spine and requires emergency surgery to prevent permanent nerve damage.
Radiological assessment – Part 2
Presented by:
Dr David Lisle — Radiologist
Event:
Bundaberg GP & Allied Health Education Day - 2015
Lbp with radiculopathy
This document provides guidelines for treating radiculopathy and back pain. It discusses:
- Common causes of back pain including ligament/muscle strains and spinal issues
- Nonsurgical and pharmacological treatment options for acute, subacute, and chronic back pain including exercise, NSAIDs, muscle relaxants, and opioids
- Surgical indications and procedures for severe or persistent back pain such as spinal fusion, disc replacement, and microdiscectomy
- Approaches to acute radiculopathy including imaging, glucocorticoids, opioids, and exercise-based rehabilitation
Appropriate imaging for low back pain
1) The document discusses appropriate imaging for back pain, describing different imaging modalities like X-rays, CT scans, bone scans, and MRI.
2) It categorizes back pain into 3 groups: nonspecific low back pain, back pain associated with radiculopathy, and back pain associated with a specific cause needing prompt evaluation.
3) Guidelines recommend triaging patients into these 3 categories and only imaging those with red flags, severe/progressive neurological symptoms, or if considering surgery/injections. Imaging is not recommended for nonspecific back pain.
Spinal cord injuries and diseases
Spinal cord injuries and diseases can cause various neurological deficits depending on the level and nature of the injury or disease. Some key points:
1. Spinal cord injuries result in changes to motor, sensory or autonomic function that can be temporary or permanent. Common causes include trauma, compression, and ischemia.
2. Different levels of injury cause specific deficits - cervical injuries may cause quadriplegia while thoracic injuries cause leg weakness and bladder/bowel issues.
3. Specific patterns include Brown-Sequard syndrome where one side is weaker and the other has loss of sensation, and central cord syndrome affecting the arms more than legs.
4. The anatomy and pathways of the spinal
Lumbosacral radiculopathy
Low back pain is one of the most common musculoskeletal complaints encountered in clinical practice. It is the leading cause of disability in the developed world and accounts for billions of dollars in healthcare costs annually. Although epidemiological studies vary, the incidence of low back pain is estimated to be anywhere between 5% to more than 30% with a lifetime prevalence of 60% to 90%. Most occurrences of low back pain are self-limited and resolve without intervention. Approximately 50% of cases will resolve within one to two weeks. 90% of cases will resolve in six to 12 weeks. The differential for low back pain is broad, and amongst other diagnoses, should include lumbosacral radiculopathy. Lumbosacral radiculopathy is a term used to describe a pain syndrome caused by compression or irritation of nerve roots in the lower back. It can be caused by lumbar disc herniation, degeneration of the spinal vertebra, and narrowing of the foramen from which the nerves exit the spinal canal. Symptoms include low back pain that radiates into the lower extremities in a dermatomal pattern. Other accompanying symptoms can include numbness, weakness, and loss of reflexes, although the absence of these symptoms does not exclude a diagnosis of lumbosacral radiculopathy.
Spinal cord injuries
Spinal cord injuries complete topic about it and how to make good rehabilitation for the patient with spinal cord injuries .
wish it help people
my pleasure :)
Mostafa shakshak
Neck and back pain
This document discusses neck pain, its causes, evaluation, and treatment. It notes that neck pain is the fourth leading cause of disability in the US. Causes include trauma, degeneration, inflammation, infection, infiltration, and compression. Neck pain is categorized as uncomplicated, radiculopathy, or myelopathy. Evaluation involves history, physical exam including tests like Spurling's sign, and imaging like x-rays or MRI. Common conditions are mechanical disorders, disc herniation, spondylosis, stenosis, cancer, and myofascial syndrome. Treatment depends on severity but may include conservative options like physiotherapy, medications, collar, or referral to specialist. Uncomplicated neck pain is usually treated with
Spinal cord injuries
- Spinal cord injuries occur most often in males aged 16-30 and result from motor vehicle accidents, violence, falls, or sports.
- Medical management includes immobilizing the spine, administering steroids to reduce swelling, and surgery to decompress the spinal cord if needed.
- Nursing management focuses on respiratory care if needed, skin integrity, bowel and bladder care, pain management, and preventing complications like infection, blood clots, and autonomic dysreflexia.
Spinal cord injury
This document provides information on spinal cord anatomy, neuroanatomy, blood supply, and injury. It describes the following:
- The spinal cord extends from the foramen magnum to the L1 vertebra and is made up of 31 spinal nerve pairs that innervate different parts of the body.
- Spinal cord injury can be complete or incomplete and results from primary mechanical damage or secondary cellular processes. Injuries are classified using scales like ASIA.
- Clinical features depend on the level and severity of injury and may include motor/sensory deficits, respiratory issues, or autonomic dysfunction. Proper history and exam are needed to evaluate patients.
- Epidemiology shows injuries
What's hot (20)
Viewers also liked
Cauda equina syndrome
This document summarizes the experience with cauda equina syndrome (CES) at AIIMS hospital in India. It reports that CES accounted for 2.76% of spinal surgeries in their series. While the duration of symptoms did not correlate with recovery outcomes, early diagnosis and surgery was recommended to stop the progression of incomplete CES lesions to complete lesions. The results showed that after surgery, 67% of patients had normal sensory function recovered, 100% of bladder functions improved or remained mild, and 45% had normal motor function recovery.
Conus medullaris and cauda equina syndromes
Here are the answers to your questions:
1. Two etiologies of conus medullaris and/or cauda equina syndrome are tumor and disc herniation.
2. The most common location for the end of the spinal cord in the adult human is the L1-L2 vertebral level, known as the conus medullaris.
Conus medullaris and cauda equina syndrome
This document discusses conus medullaris syndrome and cauda equina syndrome, two conditions that result from compression of the spinal cord or nerve roots in the lower back. It describes the differences in presentation and symptoms between the two syndromes. Specifically, conus medullaris syndrome affects the sacral cord segment and roots, presents suddenly and bilaterally, and can cause early urinary and fecal incontinence. Cauda equina syndrome affects the lumbosacral nerve roots, presents gradually and unilaterally, and tends to cause more severe radicular pain and late onset of bowel dysfunction. The document also outlines various causes of the syndromes and methods for investigating and relieving cord compression.
Cauda conus syndromes
1. The patient is a 21-year-old male who presents with a 2.5 year history of difficulty urinating, 2 year history of lower back pain, and numbness and weakness in the lower limbs over the past 2 years.
2. On examination, the patient has reduced sensation in the saddle area and lower limbs, weakness in the right lower limb, and wasting of thigh and calf muscles on the right side.
3. Based on the history and examination findings, the patient likely has conus medullaris syndrome, with signs and symptoms consistent with spinal cord compression and dysfunction in the lower lumbar and sacral regions.
Radiological assessment – Part 2
Presented by:
Dr David Lisle — Radiologist
Event:
Mackay GP & Allied Health Education Day - 2014
Syndromes Of Spinal Cord
The document discusses various syndromes of the spinal cord including complete and incomplete cord syndromes. It describes Brown-Sequard syndrome, central cord syndrome, anterior cord syndrome, posterior cord syndrome, and conus medullaris syndrome. Complete cord transection results in paralysis, sensory loss, and autonomic dysfunction below the level of injury. Incomplete syndromes can cause varying degrees of motor weakness, sensory loss, and autonomic dysfunction depending on the areas of the spinal cord affected. Specific vascular, inflammatory, and traumatic causes are discussed for each syndrome.
spinal cord - Cauda vs. conus
The conus medullaris is the lower end of the spinal cord located around the L1-L2 vertebrae. Below the conus medullaris, the spinal nerves continue as the cauda equina nerve roots. The cauda equina refers to the bundled tail of nerve roots below the end of the spinal cord. Injuries to the lower end of the spinal cord can cause bladder and bowel issues as well as saddle anesthesia, while injuries to the cauda equina can cause asymmetrical sensory loss, root pain, and fasciculations that are less common with injuries only to the conus medullaris.
Spinal Cord Syndromes-An Overveiw
1. The document discusses various spinal cord syndromes including complete cord transection syndrome, Brown-Sequard syndrome, central cord syndrome, posterior column syndrome, posterolateral cord syndrome, combined anterior horn cell-pyramidal tract syndrome, anterior horn cell syndrome, and anterior spinal artery occlusion syndrome.
2. It describes the key features of each syndrome such as the patterns of sensory and motor deficits and common causes.
3. Examples of features mentioned include flaccid paralysis, loss of all sensory modalities, and autonomic disturbances for complete cord transection syndrome and unilateral motor and sensory deficits for Brown-Sequard syndrome.
Spinal cord syndromes
The document discusses various spinal cord syndromes classified as either complete or incomplete cord syndromes. It provides details on complete cord transection which results in paralysis, loss of sensation, and autonomic dysfunction below the level of injury. Brown-Sequard syndrome and central cord syndrome are discussed as examples of incomplete cord syndromes characterized by mixed upper and lower motor neuron findings on one or both sides of the body. The document also covers syndromes involving specific regions of the spinal cord including conus medullaris, cauda equina, and anterior spinal artery syndromes.
Spinal injury ppt
Spinal cord injuries can cause partial or complete loss of motor and sensory function below the site of injury. There are several types of spinal cord injuries including complete and incomplete injuries. Risk factors include men, young adults, seniors, and those active in sports. Causes include trauma, bullet wounds, and falls. Symptoms depend on the injury level but may include paralysis, numbness, loss of bowel/bladder control. Diagnostic tests include imaging like CT, MRI to determine injury level and severity. Complications can include autonomic dysreflexia, pressure sores, loss of sexual function. Treatment involves stabilizing the spine, managing complications, and long-term rehabilitation.
Anatomy of spinal cord
The document describes the anatomy and structure of the spinal cord. It details the external structure including its cylindrical shape and location within the vertebral canal surrounded by meninges. Internally, it describes the gray and white matter, including the ascending and descending tracts that transmit sensory and motor signals. It also discusses the blood supply, clinical correlations, and applications related to injuries and diseases of the spinal cord.
Spinal cord lesions module
The patient is unable to stand or walk because he is unable to move or bear weight on his right leg. On examination:
- Strength is normal in the left leg but there is weakness of dorsiflexion and plantarflexion in the right leg.
- Reflexes are normal in the left leg but hyperreflexic in the right leg.
- Sensation to light touch, pinprick and temperature are intact throughout.
- There is spasticity in the right leg.
Damage to what system(s) is causing this patient’s problems?
Lesion of the right lateral corticospinal tract at approximately L2.
The findings are consistent with an
Open Heart Surgery
Open heart surgery is a procedure where the chest is opened and surgery is performed on the heart muscle, arteries, valves, or other parts of the heart. It is commonly used to treat coronary heart disease by performing a CABG. The surgery takes 4-6 hours under general anesthesia, involves making an 8-10 inch cut in the chest and connecting the patient to a heart-lung machine while new arteries are grafted around blocked ones. India is a popular destination for open heart surgery due to affordable costs, top cardiac surgeons, and high success rates. Major heart hospitals are located in Delhi, Mumbai, Mohali, Noida, Hyderabad, Ahmedabad, Kolkata, and Chennai.
article surabhi
This document summarizes a case report of a 32-year old woman who developed Cauda Equina Syndrome (CES) after experiencing low back pain. She underwent spinal surgery but continued experiencing symptoms like weakness, numbness, and bladder/bowel incontinence. She was treated with Ayurvedic medications, panchakarma procedures, and yoga for 3 months. Her symptoms improved, including reduced pain and numbness and improved bladder/bowel control and motor function. The treatment addressed the underlying vata imbalance and marmabhighata (injury to nerves) based on Ayurvedic principles. The case report concludes Ayurvedic treatment improved her quality of life and symptoms, demonstrating potential benefits for managing
Spinal cord injuries spinalfractures thoracolumbar fracture
The document discusses the anatomy and physiology of the thoracic and lumbar spine as well as spinal cord injuries. It provides details on:
- The anatomy of the spinal cord and cauda equina from the foramen magnum to the lumbar region
- Facet orientation and stiffness in the thoracic vs lumbar spine regions
- Mechanisms of spinal cord injury including impact forces and patient factors
- Classification of spinal injuries including compression fractures, burst fractures, and fracture dislocations
- Surgical indications for spinal injuries based on neurological involvement, fracture instability, and failure of stress testing.
Epidural abscess
An epidural abscess threatens the spinal cord by compressing it and impairing blood flow. Left untreated, the expanding infection causes sensory and motor dysfunction that progresses to paralysis or death. Risk factors include diabetes, spinal surgery/trauma, IV drug use, and immunosuppression. Abscesses form via direct extension from bone/soft tissue infections, bloodborne spread, or instrumentation. Presentation involves back/radicular pain and neurological deficits like weakness. MRI best identifies fluid collections, while blood tests and cultures identify causative organisms to guide antibiotic treatment. Urgent surgery may be needed to decompress the spinal cord if deficits are present.
Sebastian Lattuga MD; Spinal Fracture
Sebastian Lattuga MD provides patient education materials on spinal fractures
A spinal fracture is referred to as a vertebral compression fracture because when a vertebra breaks, it typically collapses and becomes compressed.
It’s important to seek treatment if you suspect you might have a spinal fracture. Early treatment can help restore the deformed vertebra to its correct shape
Open heart surgery
Open heart surgery requires that the heart be still, dry, and relaxed. The basic steps involve opening the chest, placing the patient on bypass to circulate their blood, cooling and stopping the heart, performing the intracardiac operation, closing the heart, and weaning the patient off bypass. Key parts of the procedure include cannulating major vessels like the aorta and vena cavas to connect the patient to the bypass machine, delivering cardioplegia to arrest the heart, performing the necessary incisions and repairs on the heart, and closing the chest. Developing techniques have allowed some operations to be done without placing the patient on bypass.
Basal ganglia by dr kifayat
The document discusses the basal ganglia, which initiate and control movements. It contains three main sections: anatomy, neurophysiology, and neuropathology. The basal ganglia consist of gray matter nuclei that facilitate effective movements through direct pathways and inhibit competing movements through indirect pathways. The direct pathway is excitatory and the indirect pathway is inhibitory. Dopamine regulates these pathways. Neurological diseases that affect the basal ganglia, like Parkinson's and Huntington's disease, can lead to movement disorders.
8 localized periosteal reaction
This document discusses localized periosteal reactions seen on radiographs in a variety of conditions:
1) Osteogenic sarcoma, Ewing's sarcoma, and lymphoma can present with irregular periosteal responses and bone destruction. Ewing's sarcoma specifically shows laminated and thin periosteal elevations.
2) Chronic leukemia causes pronounced periosteal new bone formation around long bones.
3) Other conditions like aneurysmal bone cyst, chronic osteomyelitis, Reiter's syndrome, vascular stasis, Caffey's disease, syphilis, yaws, and tropical ulcers can also present with periosteal reactions and new bone formation in characteristic patterns.
Viewers also liked (20)
Spinal cord injuries spinalfractures thoracolumbar fracture
Spinal cord injuries spinalfractures thoracolumbar fracture
Similar to Cauda equina
dual process
Paramedics use both intuitive and analytical thinking processes in clinical decision making. Errors often arise due to cognitive biases that influence thinking under pressure. Strategies can be applied to reduce errors, such as thoroughly investigating initial impressions, identifying red flags, ruling out worst-case scenarios, and using clinical decision tools. History taking is especially important, as it can lead to the right diagnosis 80% of the time.
Cognitive biases
The document discusses critical thinking and decision making in clinical contexts. It introduces dual process theory and how clinicians rely more on intuitive System 1 thinking which can lead to cognitive biases. Some biases discussed include availability bias, anchoring bias, confirmation bias, and search satisficing bias where clinicians fixate on initial diagnoses and do not fully consider alternatives. The document emphasizes the importance of balancing intuitive and analytical thinking to make well-informed decisions.
Management of spinal trauma
Spinal trauma management involves immobilization, intravenous fluids, medications, and prompt referral. Anatomy and mechanisms of injury vary by spinal region. Evaluation assesses neurological function using dermatomes, myotomes, and reflexes to localize injury level. Injuries may cause hypovolaemic or neurogenic shock. Corticosteroids within 8 hours may improve outcomes but evidence is limited. Prompt management aims to prevent secondary spinal cord injury.
Ppt paper presentation percutaneous discectomy
This ppt was presented by Dr Sunil Dutt JR Depart. of Anaesthesia IGMC Shimla at NZISACON-2014 at Acharya Shri Chander College of Medical Sciences and Hospital Jammu
UCMS: Prelim Medical Quiz2018
- An 8-year-old boy presented with developmental delay, seizures, mandibular prognathism, strabismus, and unusual facial expressions. Exams found unsteady gait but normal muscle tone and reflexes.
- Genetic testing identified the genetic basis as Angelman syndrome.
Paramedic update part 2
The document discusses invasive airway management and the controversies surrounding endotracheal intubation by paramedics. It emphasizes the importance of the paramedic using good clinical decision making to select the most appropriate airway intervention for each patient. While endotracheal intubation can be very effective when performed correctly, it also carries risks, and success rates for paramedics have been reported as low. The document suggests paramedics can help preserve their ability to perform endotracheal intubation by improving patient selection, confirmation of proper tube placement, and ongoing training.
BILE DUCT INJURY__:PREVENTION :MANAGEMENT;When bad things happen to good surg...
BILE DUCT INJURY__:PREVENTION :MANAGEMENT;When bad things happen to good surg...DR FIAZ FAZILI MUBARAK HOSPITAL SRINAGAR KASHMIR
Masjid Nabawi is the dream destination for any believer. The document includes prayers and blessings for Prophet Muhammad. It emphasizes visiting the mosque and sending prayers and blessings to the Prophet with each step. The vision is to provide the right care for every person every time through various strategies to lower the rate of bile duct injuries during laparoscopic cholecystectomy.Spinal nerve root entrapment.pptx
This document discusses spinal nerve root entrapment and spinal cord compression. It begins by describing the anatomy of the spinal cord and roots. It then discusses various causes of spinal cord compression including traumatic, inflammatory, neoplastic, degenerative, and vascular etiologies. Signs and symptoms of spinal cord compression include pain, progressive motor weakness, sensory disturbance, and sphincteric disturbance. Radiological investigations and treatments are also summarized. Spinal nerve root entrapment can result from disk herniation, trauma, or degeneration and causes radicular pain. Diagnosis involves tests like straight leg raise and imaging modalities like MRI. Treatment focuses on conservative measures like medication, physical therapy, and injections.
Rapid review regarding management of TRAUMTIC SPINAL CORD INJURY.pptx
A rapid review for post graduate general surgery residents about Traumatic spinal cord injury
Myasthenia gravis ppt
MYASTHENIA GRAVIS - DEFINITION,CAUSES, PATHOPHYSIOLOGY, DIAGNOSTIC FINDINGS, CLINICAL MANIFESTATION, MANAGEMENT, COMPLICATIONS
Pancreatic trauma.pptx
1. The document provides tips for using a PowerPoint presentation on pancreatic injuries. It recommends asking students questions about blank slides to promote active learning and reviewing questions after presenting each slide.
2. The PowerPoint covers relevant topics on pancreatic injuries including anatomy, grading, clinical features, investigations, management, and complications. Imaging studies like CT are important for diagnosis but an unstable patient should not be sent for CT or MRI.
3. Management depends on injury grade and location. Minor injuries may only require drainage while ductal injuries often require distal pancreatectomy. Penetrating injuries usually require laparotomy while observation may be appropriate for select blunt injuries.
Preoperative nursing care
1. The document discusses perioperative nursing care, describing the three phases - preoperative, intraoperative, and postoperative.
2. In the preoperative phase, nurses conduct assessments, educate patients, and prepare them physically and psychologically for surgery.
3. The intraoperative phase involves monitoring the patient's physiological status and ensuring a sterile environment during the surgical procedure.
4. Different types of anesthesia are described, including general, local/regional, conscious sedation and spinal anesthesia, along with their risks and complications.
Differential diagnosis
Aims: to give clinicians tools they can use to improve their ability to reflect on a differential dx and aid in correct diagnosis
Objectives:
-- define a dual process cognitive model used when making a diagnosis
-- recognize common heuristics and their related cognitive errors and biases
-- apply a systematic, routine method for differential diagnosis generation.
Veterinary Acupuncture & chiroptactice
Veterinary acupuncture and chiropractic are alternative therapies that can treat a wide range of conditions in animals. Acupuncture involves inserting needles at acupuncture points along meridian channels to normalize homeostasis and promote self-healing. It is commonly used to treat pain, arthritis, injuries, and gastrointestinal or reproductive issues. Chiropractic manipulates the spine to treat diseases and improve quality of life by ensuring normal range of motion of vertebrae. Both therapies require licensed practitioners with specialized training and are considered safe when performed properly.
Extrapyramidal disorders (Parkinson disease)
This document presents a case study of a 58-year-old man complaining of nagging pain in his right arm for 3 months. His wife has observed decreased arm swing when walking and smaller handwriting. The document discusses Parkinson's disease, defining it as a progressive neurodegenerative disorder affecting the extrapyramidal motor system due to dopamine neuron degeneration. Key risk factors are increasing age and exposure to toxins. Clinical features include tremors, rigidity, hypokinesia, and abnormal gait and posture. The pathophysiology involves loss of inhibitory influence in the basal ganglia circuitry without sufficient dopamine.
neonatalseizures-150504234526-conversion-gate01.pptx
Neonatal seizures constitute a medical emergency, as they indicate potential brain damage. Subtle seizures are most common in newborns. Hypoglycemia and hypocalcemia are common treatable causes, and should be addressed before initiating anti-seizure medications. Comprehensive management involves emergency care during seizures, diagnostic workup including blood tests and imaging to identify underlying etiologies like hypoxic-ischemic encephalopathy, and psychosocial support for the family.
Intraoperative mwdial surgical nursing .pdf
This document provides information on intraoperative nursing management. It begins with learning objectives focused on identifying the surgical team, principles of asepsis, surgical risks, anesthesia types, and applying the nursing process. It then describes the surgical team members and their roles, including the surgeon, scrub nurse, circulating nurse, and anesthesiologist. It also discusses the surgical environment, zones of the operating room, and health hazards. Finally, it covers preoperative checklist, medications, anesthesia types, patient positions, intubation, laparoscopic/robotic surgery, and post-anesthesia care including assessments, equipment, admissions, and potential complications.
PRE ANAESTHETIC CHECKUP newww.pptx
1. Pre-anesthetic evaluation involves assessing the patient's medical history and conducting a physical exam to optimize the patient for anesthesia and surgery and reduce risks.
2. The evaluation identifies comorbidities, medications, and functional status to ensure safe anesthesia delivery and predict postoperative needs.
3. Relevant lab tests may be ordered depending on patient history to further evaluate organ function and bleeding risks.
BILE DUCT INJURY DURING LAPAROSCOPIC cholecystectomy- causes-detection;manage...
Bile duct injuries (BDI) take place in a wide spectrum of clinical settings. The mechanisms of injury, previous attempts of repair, surgical risk and general health status importantly influence the diagnostic and therapeutic decision-making pathway of every single case. A multidisciplinary approach including hepatobiliary surgeon , endoscopy and interventional radiology specialists is required to properly manage this complex disease-the best treatment is prevention--do no more harm-have low threshold for conversion;call for help of seniors or expertise or refer to higher center
Traumatic paraplegia & bladder management by dr ashutosh
1) Traumatic paraplegia refers to spinal cord injury in the thoracic, lumbar, or sacral regions resulting in loss of muscle strength in the lower extremities. Initial management involves immobilization and transport to the emergency room for evaluation.
2) The bladder is commonly affected after paraplegia, resulting in either a flaccid or spastic bladder depending on the level of injury. Long-term management involves preventing complications like pressure ulcers, spasticity, and blood clots through rehabilitation therapies.
3) Rehabilitation is critical after spinal cord injury and involves a multidisciplinary team to address issues like bladder management, skin care, spasticity management, and prevention of secondary complications. The
Similar to Cauda equina (20)
BILE DUCT INJURY__:PREVENTION :MANAGEMENT;When bad things happen to good surg...
BILE DUCT INJURY__:PREVENTION :MANAGEMENT;When bad things happen to good surg...
Rapid review regarding management of TRAUMTIC SPINAL CORD INJURY.pptx
Rapid review regarding management of TRAUMTIC SPINAL CORD INJURY.pptx
neonatalseizures-150504234526-conversion-gate01.pptx
neonatalseizures-150504234526-conversion-gate01.pptx
BILE DUCT INJURY DURING LAPAROSCOPIC cholecystectomy- causes-detection;manage...
BILE DUCT INJURY DURING LAPAROSCOPIC cholecystectomy- causes-detection;manage...
Traumatic paraplegia & bladder management by dr ashutosh
Traumatic paraplegia & bladder management by dr ashutosh
Cauda equina
- 1. Cauda Equina Syndrome Tom Fearnehough YAS Paramedic in Sheffield
- 2. Objectives ● To gain a better understanding of causes symptoms and treatment of Cauda Equina Syndrome ● To gain a better understanding of the thought processes involved in clinical decision making.
- 3. Clinical Decision Making ● The environment in which paramedics work encourages them to make rapid and intuitive decisions based on first impressions (Croskerry 2009). ● Although the intuitive approach is useful (e.g. STEMI, cardiac arrest) it can lead paramedics to ignore possible differential diagnoses.
- 4. Dual Process Theory ● Dual process theory recognises the role of intuitive (system 1) and analytical (system 2) thought processes in clinical decision making. ● By combining these two approaches an initial hypothesis can be rigorously tested and reduce the likelihood of clinical error (Croskerry 2009).
- 5. Dual Process Theory (adapted from Coskerry 2009) System 1 System 2 Cognitive Style Intuitive Analytical Speed Fast Slow Effort Low High Awareness Low High Reliability Low High Scientific rigour Low High Bias High Low
- 6. Scenario ● I had attended a number of patients during the week who had mechanical falls with no injuries and had pressed their alarm pendant. ● All of these patients had been left at home a referred to the falls team. ● Terrafix flashes up the message '82 year old male – fallen – the patient is still on the floor'
- 7. Clinical Impression – mechanical fall System 1 System 2 Cognitive Style Intuitive Analytical Speed Fast Slow Effort Low High Awareness Low High Reliability Low High Scientific rigour Low High Bias High Low
- 8. Scenario (continued) ● I am met at the door by a very apologetic lady who says she only wanted the alarm company to help her husband off the floor. ● Upstairs I find the patient sat on the floor by the bed. He says that he doesn't need an ambulance as he's only slipped off the bed whilst trying to put his socks on.
- 9. Clinical impression – Mechanical fall System 1 System 2 Cognitive Style Intuitive Analytical Speed Fast Slow Effort Low High Awareness Low High Reliability Low High Scientific rigour Low High Bias High Low
- 10. Scenario (continued) ● The patient is quite large so I call back the alarm company to ask for assistance – no such luck! ● I call control to request a crew or a car with a mangar elk to assist with a lift. ● Time to kill... practice some patient assessment skills.
- 11. Scenario (continued) ● PMH – sciatica, arthritis ● Medications – paracetamol ● History – increased sciatic type pain and back pain since yesterday which prevented him doing his daily walk to the newsagents. – slipped off the bed trying to put socks on.
- 12. Clinical impression – Mechanical fall System 1 System 2 Cognitive Style Intuitive Analytical Speed Fast Slow Effort Low High Awareness Low High Reliability Low High Scientific rigour Low High Bias High Low
- 13. Scenario (continued) ● Observations – within normal parameters ● Neuro – FAST -ve / PEARL / CN II – XII intact ● Respiratory – normal ● Abdominal – normal (no urinary symptoms***) ● Cardiovascular – normal, ECG - NSR ● Musculoskeletal – no injuries / normal range of movement. Back pain and bilateral sciatic
- 14. Clinical impression – Mechanical fall System 1 System 2 Cognitive Style Intuitive Analytical Speed Fast Slow Effort Low High Awareness Low High Reliability Low High Scientific rigour Low High Bias High Low
- 15. Scenario (continued) ●● Assessment● Assessment of sensation in lower limbs – both sides the same. ● 'Do you have any numbness or tingling anywhere?'
- 16. Scenario (continued) Patient mentions that he has not been able to feel the toilet paper when he wiped his bottom.
- 17. Clinical impression – Cauda Equina Syndrome? System 1 System 2 Cognitive Style Intuitive Analytical Speed Fast Slow Effort Low High Awareness Low High Reliability Low High Scientific rigour Low High Bias High Low
- 18. The Cauda Equina
- 19. Cauda Equina Syndrome ● Cauda equina syndrome is caused by compression of the cauda equina. ● It can be caused by – vertebral disc herniation (most common) – lower back surgery – tumours – trauma – congenital defects
- 20. Cauda Equina Syndrome ● Symptoms include: – back pain – unilateral / bilateral sciatica – bladder and / or bowel dysfunction – reduced sensation in the saddle (perineal) area – sexual dysfunction – possible neurological deficit in the lower limb (motor/sensory loss, reflex change).
- 21. Cauda Equina Syndrome ● Pre-hospital treatment – analgesia – spinal immobilisation unnecessary unless the cause is traumatic – rapid transport to A&E with ASHICE call ● Hospital treatment – MRI scan asap – Surgery (within 24-48 hours)
- 22. References / Further Reading ● CROSKERRY, Pat (2009). Clinical cognition and diagnostic error: Applications of a dual process model of reasoning. Advances in Health Sciences Education: Theory and Practice, 14 Suppl 1 , 27-35. ● PILBERY, Richard (2014). Cauda equina syndrome – trouble with the horses tail? standbycpd.com/store. ● http://www.cesassociation.org.uk/
- 24. In Summary ● A dual processes approach combining system 1 and system 2 should be used in clinical decision making. ● We should be aware of the causes, symptoms and treatment for Cauda Equina Syndrome.