The clinical features and outcome of scan-negative and scan-positive cases in suspected cauda equina syndrome: a retrospective study of 276 patients

Ingrid Hoeritzauer, Savva Pronin, Alan Carson, Patrick Statham, Andreas K Demetriades, Jon Stone

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND: The majority of patients presenting with suspected clinical cauda equina syndrome (CES) have no identifiable structural cause for their symptoms ('scan-negative' CES). Understanding these patients aids clinical differentiation and management in CES.

METHODS: A retrospective electronic note review was undertaken of patients presenting with suspected CES, defined as ≥ 1 of acute bladder, bowel, sexual dysfunction or saddle numbness, to a regional neurosciences centre. We investigated radiology, clinical features, psychiatric and functional disorder comorbidities and outcome of patients with 'scan-negative' CES and patients with MRI confirmed compression of the cauda equina ('scan-positive' CES).

RESULTS: 276 patients were seen over 16 months. There were three main radiologically defined patient groups: (1) 'scan-positive' CES (n = 78, mean age 48 years, 56% female), (2) 'scan-negative' CES without central canal stenosis but with lumbosacral nerve root compression not explaining the clinical presentation (n = 87, mean age 43 years, 68% female) and (3) 'scan-negative' CES without neural compromise (n = 104, mean age 42 years, 70% female). In the two 'scan-negative' groups (no neural compromise and nerve root compression), there were higher rates of functional disorders (37% and 29% vs. 9%), functional neurological disorders (12% and 11% vs 0%) and psychiatric comorbidity (53% and 40% vs 20%). On follow-up (mean 13-16 months), only 1 of the 191 patients with 'scan-negative' CES was diagnosed with an explanatory neurological disorder (transverse myelitis).

CONCLUSIONS: The data support a model in which scan-negative cauda equina syndrome arises as an end pathway of acute pain, sometimes with partly structural findings and vulnerability to functional disorders.

Original languageEnglish
JournalJournal of Neurology
Volume265
Issue number12
Early online date8 Oct 2018
DOIs
Publication statusPublished - Dec 2018

Fingerprint Dive into the research topics of 'The clinical features and outcome of scan-negative and scan-positive cases in suspected cauda equina syndrome: a retrospective study of 276 patients'. Together they form a unique fingerprint.

Cite this