Cauda Equina Syndrome, a Disease with Various Presentations and Potential for Misdiagnosis: Educational Corner

Cauda equina syndrome (CES) is a condition in which a bundle of nerves at the end of the spinal cord is injured. Usually, it presents with low back pain (LBP), pain sciatica (radiated down the leg), lower extremity weakness or sensory impairment, numbness around the anus, and bladder and bowel control loss. It could start rapidly or gradually due to disc herniation (most common), spinal stenosis, cancer, trauma, epidural abscess, and epidural hematoma (1). After suspected clinical symptoms, medical imaging is required for confirmation of diagnosis. Laminectomy is needed to relieve the pressure on the cauda equina within 48 hours. Timing to surgery is vital, though the best time to conduct it remains controversial. Permanent sequel such as incontinency, sexual dysfunction, or numbness may still happen. Even despite laminectomy, 20% of patients experience poor outcomes (2). We aimed to review the CES and its symptoms to avoid misdiagnosis as the case introduced in this paper.