Epidural compression syndromes: Difference between revisions
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**Saddle anesthesia | **Saddle anesthesia | ||
**Decreased anal sphincter tone (60-80% pts) | **Decreased anal sphincter tone (60-80% pts) | ||
*Symptoms worsened by coughing (increases intraspinal pressure) | |||
==Management== | ==Management== | ||
Revision as of 05:48, 12 December 2012
Background
- Includes spinal cord compression, cauda equina syndrome, conus medullaris syndrome
- Presentation and initial management are similar; difference is level of neuro deficit
Etiology
- Epidural abscess
- Malignancy
- Massive mid-line disk herniation
- Spinal canal hemorrhage
Clinical Features
- Back pain with neuro deficits
- Weakness in lower extremities, paresthesias/sensory deficits, gait difficultly
- Cauda equina syndrome
- Urinary retention with or without overflow incontinence (Sn 90%, Sp 95%)
- Rectal incontinence
- Bilateral sciatica
- Saddle anesthesia
- Decreased anal sphincter tone (60-80% pts)
- Symptoms worsened by coughing (increases intraspinal pressure)
Management
- Dexamethasone 10mg IV (give before obtaining any confirmatory tests)
- MRI
- If considering compression due to neoplasm obtain scan of entire spine
Source
- Tintinalli