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Cauda Equina Syndrome and Medical Negligence

Cauda Equina Syndrome is a relatively rare condition. There are only about 100 new cases of this syndrome annually in England but it is estimated that at least 10% of these are mismanaged and involve litigation against the NHS. This article explores the effects of a delayed or misdiagnosis, and what to do if your health has been compromised as a result.

Causes and Symptoms of Cauda Equina Syndrome

Cauda Equina Syndrome is when the bundle of nerves located at the lower end of the spinal cord called the 'cauda equina' becomes compressed. This in turn means the lower part of the body loses the ability to function correctly. There are a number of reasons Cauda Equina may develop, such as:-

  • Spinal tumours;
  • Prolapsed disc;
  • Traumatic injury;
  • Inflammatory conditions;
  • Infectious conditions;
  • Damage sustained during an operation.

Whatever the cause, it is crucial that the symptoms of Cauda Equina Syndrome are noted by a medical professional, as this will help lead to a swift diagnosis. Symptoms to look for include:-

  • Dysfunction of bowel, bladder or sexual function;
  • Sensory changes in saddle or perineal area;
  • Back pain;
  • Sensory changes or numbness in the lower limbs;
  • Lower limb weakness;
  • Reduction or loss of reflexes in the lower limbs.

Cauda Equina Syndrome and Delayed or Missed Diagnosis

The symptoms of Cauda Equina can, however, be mistaken for other common complaints, such as bladder, bowel, and sexual problems. It is for this reason that medical staff should in particular pay attention to the 'red flag' symptoms, which are:-

  • Severe low back pain;
  • Sciatica;
  • Saddle and genital sensory numbness;
  • Bladder, bowel and sexual dysfunction;
  • Has not passed urine for 6 8 hours.

If Cauda Equina Syndrome is suspected, it should be treated as a medical emergency. An MRI or CT scan can be used to confirm the condition, which if detected will usually require immediate surgery to decompress the nerves.

The emergency element in treating Cauda Equina Syndrome is of vital importance, because the longer compression continues, the more likely there is to be long term neurological damage. It is accepted that decompression of the nerves must be achieved within 24 hours of a patient presenting with an incomplete syndrome (the primary stage) if they are to be prevented from progressing to a complete stage of the syndrome. If left untreated, a patient is likely to suffer permanent damage. This may include chronic pain, loss of bowel and bladder control, partial or total paralysis of the legs, loss of sensation in the legs and feet, and sexual dysfunction.

Occasionally, the diagnosis of Cauda Equina Syndrome can either be missed or delayed because patients were put off seeking medical help due to embarrassment. But what other reasons are there? Common causes include:-

  • GPs not recognising the 'red flag' symptoms;
  • Junior accident and emergency staff misdiagnosing the condition;
  • Junior accident and emergency staff not calling for a consultant;
  • Hospital delays in admission to surgical units and in arranging MRI scans and surgery within an appropriate period and conducted by a suitably experienced team;
  • Failure to warn of neurological damage prior to surgery for Cauda Equine Syndrome;
  • Deficiencies in after care.

If Cauda Equina Syndrome failed to be diagnosed for any of the above reasons, then it is likely this will amount to medical negligence. If this has happened to you and your health has been negatively affected as a direct result of the care you received in hospital, then you may be entitled to compensation. For further advice, you should contact a medical negligence solicitor, who can then assess your claim and provide you with an expert legal opinion.

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