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.
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).
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.