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Brit Long breaks down the characteristics, diagnosis, pitfalls, and clinical conundrums in patients with suspected cauda equina syndrome.
Although there's passing reference to "lower motor dysfunction" as a symptom of cauda equina syndrome, the majority of this talk is on more subtle neurologic assessment.
Nonetheless, I've reviewed multiple cases (med/mal claims) where the patient was never walked in the ED, and indeed, never walked again after leaving the ED. The documented neuro exam in such cases (if there really even was one) was often something like "moves all extremities."
So I agree, assessing for subtle perineum area dysfunction is appropriate, but for heaven's sake, get the patient out of bed and walk them. Remember the old adage, "The patient doesn't go home unless they can get up and walk out the door."
David Glaser, Denver
Well said Dave! Sometimes we lose the forest for the trees and the obvious stuff gets overlooked.
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