Musculoskeletal · UKMLA & AKT
Cauda equina syndrome
A free high-yield preview for the UKMLA Applied Knowledge Test, covering how to recognise this condition. The full SA Note notes add investigations, management and complications, with practice questions on this topic.
Key high-yield points
- Low back pain - severe; bilateral sciatica is a warning sign
- Saddle anaesthesia - loss of sensation in perineum, perianal area, inner thighs (S2-S4); most specific feature
- Urinary dysfunction - difficulty initiating micturition or loss of urge to void, progressing to painless urinary retention; overflow incontinence is a late sign
- Bowel dysfunction - loss of rectal fullness sensation, faecal incontinence, reduced anal tone on digital rectal examination
- Bilateral lower limb weakness - typically asymmetrical; LMN pattern: flaccid weakness, absent or reduced reflexes
CES produces LMN signs (flaccid weakness, absent reflexes, dermatomal sensory loss) - nerve roots below L1-L2 are compressed, not the cord itself. Hyperreflexia or extensor plantars suggest a higher lesion.
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