Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.
Medical Author:
William C. Shiel, Jr., MD, FACP, FACR
Medical Editor: Charles Davis, MD, PhD
Symptoms of cauda equina syndrome include:
low back pain,
pain in one or both legs that starts in the buttocks and travels down the back of the thighs,
bladder and bowel problems (inability or
difficulty to urinating, incontinence,
constipation),
weakness in the lower extremities and loss of sensations,
numbness in the groin area, and
reduced or absent lower extremity reflexes.
What is cauda equina syndrome?
Cauda equina syndrome is an uncommon compression of the nerves at the end of
the spinal cord within the spinal canal. The terminology, "cauda equina,"
literally means tail of horse and refers to the normal anatomy of the end of the
spinal cord in the low back where it divides into many bundles of nerve tracts
resembling a horse's tail. Compression of the spinal cord at this level can lead
to a number of typical symptoms of the syndrome (low back pain,
sciatica, saddle
sensory changes, bladder and
bowel incontinence, and lower extremity motor and
sensory loss).
What are the causes of cauda equina syndrome?
Cauda equina syndrome can be caused by any condition that results in direct
irritation or pinching of the nerves at the end of the spinal cord. Causes of
cauda equina syndrome include herniation of lumbar intervertebral discs,
abnormal growths (tumor or cancer) adjacent to the lower spinal cord, localized
infection near the spinal cord (epidural abscess), and localized bleeding
(epidural hematoma) causing pressure on the spinal cord in the low back.
Localized lumbar tumors that can lead to cauda equine syndrome include
ependymomas, metastatic cancer, and Paget's disease of bone. Localized infection
near the spinal cord can be caused by staphylococcus bacteria, tuberculosis
bacteria (Mycobacterium tuberculosis from Pott's disease), and others.
Sciatica pain, caused by irritation of the sciatic nerve, typically radiates from the low back to behind the thigh to below the knee. Disc herniation is usually the cause of sciatica. Medication to alleviate pain, physical therapy, and bed rest are treatments for sciatica.
There are many causes of back pain. Pain in the low back can relate to the bony lumbar spine, discs between the vertebrae, ligaments around the spine and discs, spinal cord and nerves, muscles of the low back, internal organs of the pelvis and abdomen, and the skin covering the lumbar area.
Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis bacteria. Symptoms include weakness, fever, weight loss, night sweats and in worse cases, chest pain, shortness of breath, and coughing up blood. A person with an active infection (a positive TB skin test, abnormal chest x-ray and TB bacteria in their sputum) requires treatment with izoniazid, rifampin, ethambutol and pyrazinaide.
A hematoma is a collection of blood that is outside a blood vessel. There are different areas where hematomas occur including the inside the skull, scalp, ear, septum, bones, finger and toenails, and intra-abdominal. Treatment for hematomas depend on the type and location of the hematoma.
Paget's disease is a chronic bone disorder due to irregular breakdown and formation of bone tissue. Symptoms of Paget's disease include bone pain, headaches and hearing loss, pressure on nerves, increased head size, hip pain, and damage to cartilage of joints.
A herniated disc may be caused by injury or degeneration from age. Symptoms depend on the location of the herniation and whether nerve tissue is being irritated. An MRI or CT scan is performed to diagnose a herniated disc. Treatment may involve physical therapy, cortisone injection, pain medications, antiinflammatory medications, muscle relaxants, and surgery.
Cancer is a disease caused by an abnormal growth of cells, also called malignancy. It is a group of 100 different diseases, and is not contagious. Cancer can be treated through chemotherapy, a treatment of drugs that destroy cancer cells.
Degenerative disc disease makes the disc more susceptible to herniation (rupture) which can lead to localized or radiating pain. The pain from degenerative disc or joint disease of the spine is usually treated conservatively with intermittent heat, rest, rehabilitative exercises and medications to relieve pain, muscle spasm and inflammation.
Though it's difficult to say why some people develop cancer while others don't, research shows that certain risk factors increase a person's odds of developing cancer. These risk factors include growing older, family history of cancer, diet, alcohol and tobacco use, and exposure to sunlight, ionizing radiation, certain chemicals, and some viruses and bacteria.
There are many types of urinary incontinence (UI), which is the accidental leakage of urine. These types include stress incontinence, urge incontinence, and overflow incontinence. Urinary incontinence in men may be caused by prostate or nerve problems. Treatment depends upon the type and severity of the UI and the patient's lifestyle.
Bowel or fecal incontinence refers to the loss of voluntary control of stool, or bowel movements. The condition can include partial incontinence, in which a person loses only a small amount of liquid waste, to complete incontinence, in which the entire bowel movement cannot be controlled. Diet changes and elimination of certain medications can help patients to regain bowel control. Treatment involves a combination of medication, biofeedback, and exercise.
Millions of women suffer from urinary incontinence (UI). UI occurs twice as often in women as in men. There are many types of urinary incontinence: stress incontinence, urge incontinence, overactive bladder, functional incontinence, overflow incontinence, transient incontinence, and mixed incontinence.
Urinary incontinence in children (enuresis) is twice as common in boys as in girls and may occur during the daytime or nighttime. Nighttime urinary incontinence is also called bedwetting and sleepwetting. The cause of nighttime incontinence in children is unknown. Daytime incontinence in children may be caused by an overactive bladder. Though many children overcome urinary incontinence naturally, it may be necessary to treat incontinence with medications, bladder training and moisture alarms, which wake the child when he or she begins to urinate.
A nerve conduction velocity test (NCV) is an electrical
test that is used to determine the adequacy of the conduction of the nerve
impulse as it courses down a nerve. This test is used to detect signs of nerve
injury.
In this test, the nerve is electrically stimulated, and
the electrical impulse 'down stream' from the stimulus is measured. This is
usually done with surface patch electrodes (they are similar to those used for
an electrocardiogram) that are placed on the skin over the nerve at various
locations. One electrode stimulates the nerve with a very mild electrical
impulse. The resulting electrical activity is recorded by the other electrodes.
The distance between electrodes and the time it takes for electrical impulses to
travel between electrodes are used to calculate the speed of impulse
transmission (nerve conduction velocity). A decreased speed of transmission
indicates nerve disease. ...
