Manifestation of Acute Leriche Syndrome as Cauda Equina Syndrome

Introduction

Cauda equina syndrome is a condition affecting nerve roots caudal to the conus medullaris. Clinical diagnosis is made, if the following symptoms are present (Lavy C et al. BMJ 2009; 338: b936): Sensory changes in the perianal area and dysfunction of bladder, bowel, or sexual function. Moreover, affection of the second motoneuron can lead to uni- or bilateral sensory changes, numbness, weakness as well as reduction or loss of reflexes in the lower limbs. Another possible symptom is back pain.

The most common cause of cauda equina syndrome is nerve compression by a herniated disc which usually is considered an indication for surgical decompression (Lavy C et al.). Less frequent causes include spinal injury with fractures or subluxation, spinal neoplasms, infective causes with abscess formation, iatrogenic causes including anesthesia and postoperative complications such as hematoma and vascular pathologies (Lavy C et al. Frost S et al. J Emerg Med 1992; 10: 139 – 145).

When cauda equina syndrome is diagnosed clinically, MRI is the method of choice for further evaluation.