Cauda equina syndrome with normal MR imaging.

Area of Science:

• Neurosurgery
• Radiology
• Neurology

Background:

• Cauda equina syndrome (CES) is a neurosurgical emergency.
• Accurate diagnosis relies on clinical presentation and imaging.
• Distinguishing structural pathology from functional causes is crucial.

Purpose of the Study:

• To compare clinical characteristics of patients with and without abnormal MR imaging in suspected CES.
• To investigate the prevalence of normal imaging in CES referrals.
• To explore potential origins of CES symptoms without radiological findings.

Main Methods:

• Retrospective study of 10-month admissions to a regional neurosurgical unit.
• Analysis of clinical details from case notes for 66 patients undergoing lumbar spine MR.
• Comparison of patient demographics, history, and examination findings between groups with normal and abnormal MR imaging.

Main Results:

• No significant differences in sex, history, or examination findings between groups.
• 52% of patients (n=34) had abnormal MR imaging; 48% (n=32) had normal scans.
• Patients with normal imaging frequently reported leg weakness, saddle/leg numbness, urinary incontinence, and retention.

Conclusions:

• A substantial number of patients present with CES symptoms but lack radiological evidence of structural pathology.
• Normal MR imaging findings in suspected CES may suggest a functional origin in many cases.
• Further investigation into non-structural causes of CES symptoms is warranted.