Brooke Army Medical Center, Department of Emergency Medicine, 3841 Roger Brooke Dr, Fort Sam Houston, TX 78234, United States.
The University of Texas Southwestern Medical Center, Department of Emergency Medicine, 5323 Harry Hines Boulevard, Dallas, TX 75390, United States.
Am J Emerg Med. 2020 Jan;38(1):143-148. doi: 10.1016/j.ajem.2019.158402. Epub 2019 Aug 20.
Cauda equina syndrome (CES) may be a devastating disease with the potential for significant patient morbidity. It is essential for emergency clinicians to be aware of how to effectively diagnose and manage this condition.
This article provides a narrative review of the diagnosis and management of CES for the emergency clinician.
Cauda equina syndrome is a rare but emergent condition associated with back pain. It can result in severe morbidity and can be due to a variety of causes, most commonly vertebral disc protrusion. Diagnosis is often delayed, which may result in a poor prognosis. Red flags and findings consistent with CES include bilateral neurogenic sciatica, reduced perineal sensation, altered bladder function leading to painless urinary retention, loss of anal tone, and loss of sexual function. In isolation, history and examination findings demonstrate poor sensitivity. Symptoms may occur either suddenly or gradually, and most patients do not present with all of these symptoms. Postvoid bladder volume assessments can assist in the evaluation, but the diagnosis typically involves magnetic resonance imaging (MRI) or computed tomography myelography if MRI is not available. Treatment relies upon surgical consultation and operative intervention for decompression.
Cauda equina syndrome can be a difficult diagnosis. However, knowledge of the history and examination findings, imaging, and treatment can assist the emergency clinician in optimizing management of this condition.
马尾综合征（CES）可能是一种破坏性疾病，患者有很大的发病风险。对于急救临床医生来说，了解如何有效地诊断和治疗这种疾病是非常重要的。
本文为急救临床医生提供了马尾综合征的诊断和治疗的叙述性综述。
CES 是一种罕见但紧急的与腰痛相关的疾病。它会导致严重的发病风险，可能由多种原因引起，最常见的是椎间盘突出。诊断常常被延误，这可能导致预后不良。CES 的特征性表现包括双侧神经源性坐骨神经痛、会阴感觉减退、膀胱功能改变导致无痛性尿潴留、肛门张力丧失和性功能丧失。孤立的病史和检查结果显示出较差的敏感性。症状可能突然或逐渐出现，并非所有患者都有这些症状。排尿后膀胱容量评估有助于评估，但如果没有 MRI，通常需要进行 MRI 或 CT 脊髓造影来诊断。治疗依赖于手术咨询和减压手术。
CES 的诊断可能具有挑战性。然而，了解病史和检查结果、影像学表现和治疗方法可以帮助急救临床医生优化对这种疾病的管理。
