Cauda equina syndrome

### What you need to know A 42 year old woman presented to an out-of-hours general practitioner with a five day history of low back pain with burning pain radiating into her right foot. She had a body mass index of 39 and a 12 year history of chronic low back pain with intermittent left sided “sciatica” pain in her thigh. She had noted “tingling” in her genital area. There was no incontinence. The general practitioner considered, on examination, that anal tone and perianal sensation were normal, as were power, tone, reflexes, and sensation in the legs. The patient was treated with analgesia and given advice to seek review if she developed bilateral sciatica, became incontinent, or developed leg weakness. Three days later, she was admitted with cauda equina syndrome and underwent surgical decompression. She was left with lower limb weakness, numbness of the genitalia, loss of sexual function, and urinary and faecal incontinence. Cauda equina syndrome (CES) is a rare condition in which the …