Cauda Equina Syndrome Checklist

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Cover all the B.A.S.E.S, First! Then Walk

The Vital Checklist Way

B 
Bilateral [1]
  • If the patient has bilateral loss of motor strength, bilateral loss of sensation, bilateral loss of reflexes, bilateral radicular pain they are at high risk of cauda equina syndrome[2]
B Base
Cannot feel your base [3]
  • Do you feel the toilet paper when you wipe your bottom?
B 
Bowel and Bladder Incontinence [1]
  • Are you able to feel when your bladder or bowel are full? No! If you have painless retention of urine with overflow incontinence, check for complete cauda equina syndrome
  • Do you have sense of full bladder and then leak urine?[2]
A 
Anesthesia [1]
  • Are you able to feel in between the legs? Do you have any numbness around the anus and genitalia?
S 
Sciatica [4]
  • Does the pain radiate from the back into one leg or both legs?
E 
Erection [4]
  • Are you able to achieve erection? Are you able to ejaculate?
S 
Sensory disturbance [1]
  • Do you have numbness, tingling, loss of sensation in both legs?
F 
Fracture [5]
  • Evaluate for compression fracture and osteoporosis
I 
Infection or IV Drug USE [6]
  • Signs of infection, Inflammation and IV Drug Use
R 
Ruptured AAA [7]
  • History of smoking, ruptured AAA
S 
Sciatica [4]
  • Pain starts in the back and goes into the legs
T 
Trauma or Tumor [8, 9]
  • Any history of trauma or tumor
WWalk
If you cannot even walk, Admit! [9]
  • Can you walk? If you can’t then admit the patient. Can you get on the scale to measure your weight? If you have any unintentional weight loss, please report it to your doctor
B 
Bilateral [1]

vkidh nnZ dh txg crk ldrs gSa\

B Base
Cannot feel your base [3]

vki nnZ ds xzsM dks 1 ls 10 ij crk ldrs gSa\

B 
Bowel and Bladder Incontinence [1]

vkidk nnZ dc ls gS\

A 
Anesthesia [1]

vkidk nnZ dc izkjEHk gqvk\
;s nnZ vpkud ;k /khjs&/khjs 'kq: gqvk\

S 
Sciatica [4]

vvki vius nnZ dk o.kZu dj ldrs gSa\

E 
Erection [4]

D;k vkids nnZ esa izfrfnu cnyko gS\

S 
Sensory disturbance [1]

vki D;k dj jgs Fks tc nnZ 'kq: gqvk\

F 
Fracture [5]

D;k nnZ dgha Hkh fodh.kZ djrk gS\

I 
Infection or IV Drug USE [6]

dksbZ vU; y{k.k gS\

R 
Ruptured AAA [7]

D;k bls cnrj cuk nsrk gS\

S 
Sciatica [4]

D;k bls cgrj cuk nsrk gS\

T 
Trauma or Tumor [8, 9]

vrhr esa fdlh Hkh blh rjg dk nnZ gqvk gS\

WWalk
If you cannot even walk, Admit! [9]

vkidks dkSu lh nokvksa us enn dh\

B 
Bilateral [1]

quhwnMU drd ik`Qy hY ?

B Base
Cannot feel your base [3]

10 iv`co Awpxy drd nMU qusI ikMny nMbr dvogy ?

B 
Bowel and Bladder Incontinence [1]

quhwnMU drd ikMny smyN qoN hY ?

A 
Anesthesia [1]

quhwfw drd kdoN SurU hoieAw?
kI quhwfw drd ie`k dm jW hOlI-hOlI SurU hoieAw hY ?

S 
Sciatica [4]

Awpxy drd bwry ivsqwr ‘c d`so

E 
Erection [4]

kI quhwfy drd iv`c idn-rwq dw Prk hY ?

S 
Sensory disturbance [1]

drd SurU hox dy smyN qy qusI kI kr rhy sI ?

F 
Fracture [5]

kI quhwfw drd ie`k QW itikAw rihMdw hY jW iksy pwsy PYldw hY ?

I 
Infection or IV Drug USE [6]

koeI hor sMbMiDq l`Cx ?

R 
Ruptured AAA [7]

quhwfw drd kihVAW kwrnW krky v`Ddw hY ?

S 
Sciatica [4]

quhwfw drd bihqr ikvyN huMdw hY ?

T 
Trauma or Tumor [8, 9]

kI quhwnMU ies qrHW bIqy smyN iv`c vI kdy mihsUs hoieAw sI ?

WWalk
If you cannot even walk, Admit! [9]

vkoeI AijhI dvweI ijs ny quhwnMU bIqy smyN iv`c drd qoN Arwm id`qw hovy ?

B 
Bilateral [1]

మీ నొప్పి ఎక్కడ ఉందో చూపించగలరా?

B Base
Cannot feel your base [3]

ఒకటి నుంచి పది అనే కొలత ప్రమాణం పై మీ నొప్పి ఎంత ఉందో చెప్పగలరా?

B 
Bowel and Bladder Incontinence [1]

ఎంత కాలం నుండి మీకు ఈ నొప్పి ఉంది?

A 
Anesthesia [1]

ఇది ఎపుడు ప్రారంభం అయ్యింది? ఆకస్మాత్తుగా
మొదలైందా లేదా క్రమేపి ఆరంభం అయిందా?

S 
Sciatica [4]

మీ నొప్పిని వివరించగలరా?

E 
Erection [4]

ఊదయం సాయంత్రం సమయాల్లో నొప్పిలో ఏమైనా తేడా ఉందా?

S 
Sensory disturbance [1]

నొప్పి మొదలైనప్పుడు మీరు ఏం చేస్తున్నారు?

F 
Fracture [5]

నొప్పి ఒకే చోట ఉంటుందా లేదా ఇతర ప్రాంతాలకు వ్యాపిస్తుందా?

I 
Infection or IV Drug USE [6]

ఇంకా ఏమైనా లక్షణాలు ఉన్నాయా?

R 
Ruptured AAA [7]

ఆ బాధను అధికం చేయడానికి తోడ్పాటు అందించే కారకాలు ఏమైనా ఉన్నాయా?

S 
Sciatica [4]

ఏం చేస్తే బాగుంటుంది?

T 
Trauma or Tumor [8, 9]

గతంలో ఇలాంటి సంఘటనలు జరిగాయా?

WWalk
If you cannot even walk, Admit! [9]

గతంలో నొప్పి తగ్గించడానికి ఏమైనా మందులు ఉపయోగపడ్డాయా?

B 
Bilateral [1]

آپ کو درد کہاں ہے؟
کیا آپ درد والے حصے کی نشاند ہی کر سکتے ہیں؟

B Base
Cannot feel your base [3]

کیا آپ اپنی درد کی شدت بتا سکتے ہیں؟

B 
Bowel and Bladder Incontinence [1]

درد کب سےہو رہا ہے؟

A 
Anesthesia [1]

درد کب شروع ہوا؟
کیا یہ اچانک شروع ہوایاں وقت کے ساتھ آہستہ آہستہ بڑھا؟

S 
Sciatica [4]

کیا آپ اپنی تکلیف واضح کر سکتے ہیں؟

E 
Erection [4]

صبح یاں شام میں درد میں کوئی خاص تبدیلی؟

S 
Sensory disturbance [1]

جب درد شروع ہوا تب آپ کیا کر رہے تھے؟

F 
Fracture [5]

کیا آپ کو درد ایک جگہ ہوتا ہےیاں یہ آگے پیچھے بھی جاتا ہے؟

I 
Infection or IV Drug USE [6]

کیا آپ کو درد کے ساتھ اور کوئی تکلیف ہوتی ہے؟

R 
Ruptured AAA [7]

کیا چیز درد کو بڑھا تی ہے؟

S 
Sciatica [4]

کس چیز سے درد میں کمی آتی ہے؟

T 
Trauma or Tumor [8, 9]

پہلے کبھی ایسا درد ہوا ؟

WWalk
If you cannot even walk, Admit! [9]

کوئی دوا ئی جس کے پہلےلینے سےدرد کم ہوا ہو؟

B 
Bilateral [1]

Можете ли Вы указать, где ваша боль?

B Base
Cannot feel your base [3]

Можете ли Вы оценить интевсиноcть болью от 1 до 10?
1 = Минимальная интенсивность
10 = Максимальная интенсивность

B 
Bowel and Bladder Incontinence [1]

Как долго это продолжается?

A 
Anesthesia [1]

Когда это началось?

S 
Sciatica [4]

Можете ли Вы подробно рассказать о боли ?

E 
Erection [4]

Это началось внезапно или медленно?
Изменение боли утром или вечером?

S 
Sensory disturbance [1]

Чем Вы занимались когда начинается боль?

F 
Fracture [5]

Боль находится там где началась или иррадирует куда-нибудь ?

I 
Infection or IV Drug USE [6]

Есть другие симптомы связанные с болью ?

R 
Ruptured AAA [7]

Что усиливает боль?

S 
Sciatica [4]

Что уменьшает боль?

T 
Trauma or Tumor [8, 9]

Была ли у Вас подобная боль раньше?

WWalk
If you cannot even walk, Admit! [9]

Лекарства, которые помогают Вам с болью?

B 
Bilateral [1]

Você pode apontar onde dói?

B Base
Cannot feel your base [3]

Você pode avaliar a intensidade da sua dor entre 1 e 10?

B 
Bowel and Bladder Incontinence [1]

Há quanto tempo sente isso?

A 
Anesthesia [1]

Quando começou?

S 
Sciatica [4]

Você pode descrever sua dor?

E 
Erection [4]

A dor começou subitamente ou foi aos poucos?
Alguma mudança nos sintomas durante o dia, tarde ou à noite?

S 
Sensory disturbance [1]

O que você estava fazendo quando a dor começou?

F 
Fracture [5]

A dor se espalha ou irradia para outro lugar?

I 
Infection or IV Drug USE [6]

Existe algum outro sintoma associado?

R 
Ruptured AAA [7]

O que faz a dor piorar?

S 
Sciatica [4]

O que melhora a dor?

T 
Trauma or Tumor [8, 9]

Algum episódio semelhante no passado?

WWalk
If you cannot even walk, Admit! [9]

Alguma medicação aliviou sua dor no passado?

B 
Bilateral [1]

നിങ്ങൾക്കു എവിടെയാണ് വേദന?

B Base
Cannot feel your base [3]

നിങ്ങളുടെ വേദനയുടെ തീവ്രതയെ 1-10 വരെ ഉള്ള ഒരു സ്കെയിലിൽ തരം തിരിക്കാമോ?

B 
Bowel and Bladder Incontinence [1]

എത്രനാളായി വേദന ഉണ്ട്?

A 
Anesthesia [1]

തുടക്കം വിവരിക്കാമോ?

S 
Sciatica [4]

വേദനയുടെ സവിശേഷതകൾ എന്തെല്ലാം?

E 
Erection [4]

എപ്പോഴാണ് വേദന കൂടുതൽ?
പകലോ രാത്രിയിലോ വേദനയിൽ വ്യത്യാസം തോന്നുന്നുണ്ടോ?

S 
Sensory disturbance [1]

വേദന തുടങ്ങിയപ്പോൾ നിങ്ങൾ എന്ത് ചെയ്യുകയായിരുന്നു?

F 
Fracture [5]

വേദന മറ്റെവിടേക്കെങ്കിലും വ്യാപിക്കുന്നുണ്ടോ?

I 
Infection or IV Drug USE [6]

ഇതിനോട് അനുബന്ധിച്ചു വേറെ പ്രശ്നങ്ങൾ ഉണ്ടോ?

R 
Ruptured AAA [7]

വേദന അധികരിപ്പിക്കുന്നതു എന്തെല്ലാം?

S 
Sciatica [4]

വേദന കുറയ്ക്കുന്നതു എന്തെല്ലാം?

T 
Trauma or Tumor [8, 9]

മുൻപ് ഇതുപോലെ ഉണ്ടായിട്ടുണ്ടോ?

WWalk
If you cannot even walk, Admit! [9]

വേദന സംഹാരികൾ ഉപയോഗിക്കുന്നുണ്ടോ?

B 
Bilateral [1]

خبرني بمكان الألم؟
هل يمكنك أن تشير الى مكان الألم بالضبط

B Base
Cannot feel your base [3]

هل تستطيع ان تقيم مستوى الالم على مقياس ١-١٠؟

B 
Bowel and Bladder Incontinence [1]

منذ متى و انت تعاني من هذا الألم؟

A 
Anesthesia [1]

തുمتى بدأ عندك هذا الألم؟
هل بدء الالم بصورة مفاجئة ام تدريجية؟

S 
Sciatica [4]

هل تستطيع ان تصف لي الألم الذي تحس به؟

E 
Erection [4]

هل هناك أي تفاوت في الألم مابين النهار و المساء؟

S 
Sensory disturbance [1]

ما الذي كنت تفعله عندما بدأ عندك هذا الألم؟

F 
Fracture [5]

هل الالم باقي في مكان واحد ام انك تحس بالالم ينتشر الى اماكن اخرى؟

I 
Infection or IV Drug USE [6]

هل هناك اية اعراض اخرى مصاحبة للألم؟

R 
Ruptured AAA [7]

ما الذي يزيد من حدة الالم؟

S 
Sciatica [4]

ما الذي يساعد على التخفيف من حدة الالم؟

T 
Trauma or Tumor [8, 9]

هل عانيت من الآلام مشابهة في الماضي؟

WWalk
If you cannot even walk, Admit! [9]

هل استخدمت اية ادوية للمساعدة على تخفيف حدة الالم في السابق؟

I  
Infection of the feet or other skin issues

ನಿಮ್ಮ ಕಾಲು ವೈದ್ಯರನ್ನು ನೀವು ನಿಯಮಿತವಾಗಿ ಭೇಟಿ ನೀಡುತ್ತೀರಾ?

C  
Cholesterol(checked every 3-6 months if uncontrolled) [3]

ಕಡಿಮೆ ಮತ್ತು ಅಧಿಕ ರಕ್ತದ ಸಕ್ಕರೆಯ ದಾಖಲೆ

R  
Record of low and high blood sugars [4]

ನೀವು ನಿಮ್ಮ ಪ್ರಾಥಮಿಕ ಆರೈಕೆ ವೈದ್ಯರಿಗೆ ನಿಯಮಿತ ಅನುಸರಣೆಗಾಗಿ ಹೋಗುತ್ತೀರಾ?

U  
Urine protein and kidney function [5]

ík{ku ík{khk VeÍeþeÞLkLke rLkÞr{ík {w÷kfkík ÷E hõík [fkMkýe yLku ÞwrhLk xuMx fhkðku Aku ?

S  
Sleep apnea [6]

ô½{kt LkMkfkuhk çkku÷u Au ?
ík{kuLku Ãkqhíkk «{ký{kt Wt½ LkÚke ykðíke íkuðwt ÷køku Au ?
rËðMk ËhBÞkLk Úkkfu÷k ÷køkku y™u ô½ s ykÔÞk fhu íkuðwt ÷køku Au?

H  
Heart disease [7, 8]

ík{kuLku ÓËÞ hkuøk Au ?

D  
Depression [9]

ík{ku WËkMkeLkíkk fu níkkþk y™w¼ðku Aku ?

I  
Impotence [10]

ík{kuLku ®÷øk Lkk WíÚkkLk{kt ftE VuhVkh ÷køku Au ?

A  
A1C [11, 12]

Hb A1c rLkÞr{ík [fkMkýe fhkuðku Aku ?

B  
Blood pressure [13]

ík{kuLku nkE çkeÃke Au ?

E  
Eye: Diabetic retinopathy [14, 15]

ík{u rLkÞr{ík ík{khe ykt¾Lke íkÃkkMk ykt¾Lkk zkuõxh ÃkkMku fhkðe Au ?

T  
Tingling/ numbness in limbs: Diabetic Neuropathy [16]

zkÞkçkexef LÞwhkuÃkÚke ÷kune ¼ú{ý fu MktðuËLk{kt ½xkzku ?

E  
Ear check-up (Peripheral neuropathy) [17]

ík{kuLku Mktíkku÷Lk ò¤ððk{kt fu Mkkt¼¤ðk{kt fkuE íkf÷eV ?

S  
Stomach problems (Gastroparesis, constipation) [18-20]

ík{kuLku ðnu÷e ík]ÂÃík, Wçkfk, W÷xe fu sBÞk ÃkAe ÃkuxLkwt Vw÷ðwt ÚkkÞ Au?
ík{kuLku fçkrsÞkík Au ?

B 
Bilateral [1]

ík{ku Lku [ku¬Mk heíku õÞkt Ëw¾kðku ÚkkÞ Au íku çkíkkðku

B Base
Cannot feel your base [3]

ík{ku Lku 1 Úke 10 Lkk «{ký{kt fux÷ku Ëw¾kðku ÚkkÞ íku çkLkkðe þfku ?

B 
Bowel and Bladder Incontinence [1]

fux÷k Mk{ÞÚke Ëw¾kðku ÚkkÞ Au ?u

A 
Anesthesia [1]

õÞkhÚke Ëw¾kðkLke þYykík ÚkE ?

S 
Sciatica [4]

ík{u Ëw¾kðk rð»ku ðÄw rðøkíkðkh sýkðe þfku Aku ?

E 
Erection [4]

íkuLke þYykík yufkyuf ÚkE fu Äe{u Äe{u ?
Mkðkh Mkkts ík{khk Ëw¾kðk{kt fkuE VuhVkh ?

S 
Sensory disturbance [1]

ftR «ð]r¥k{kt Mktf¤kÞu÷k nkuÞ íÞkhu Ëw¾kðku ÚkkÞ Au ?

F 
Fracture [5]

Ëw¾kðku yuf s søÞkyu Au fu þhehLkk yLÞ ¼køk{kt Ãký «Mkhu Au ?

I 
Infection or IV Drug USE [6]

çkeò yLÞ ÷ûkýku ?

R 
Ruptured AAA [7]

fkuLkkÚke íku{kt ðÄw økt¼eh ÚkkÞ Au ?

S 
Sciatica [4]

fkuLkkÚke Ëw¾kðk{kt hkník ÷køku Au ?

T 
Trauma or Tumor [8, 9]

¼qíkfk¤{kt ykðwt fkuE ð¾ík ÚkÞu÷wt ?

WWalk
If you cannot even walk, Admit! [9]

fkuE ËðkÚke ¼qíkfk¤{k Ëw¾kðk{kt hkník ÚkÞu÷e ?t

B 
Location [1,2]
  • Puedes apuntar donde te duele?
G Good
Grade
  • Del 1 al 10, cual es la intensidad del dolor?
D 
Duration [3]
  • Desde cuando sientes esto?
O 
Onset
  • Cuando empezo?
C 
Character/ Quality
  • Puedes describir tu dolor?
T 
Time of the day [4]
  • Los síntomas surgieron subitamente o surgieron de forma gradual?
  • Algun cambio en los síntomas durante el día, tarde o noche?
O 
Occasion [5]
  • Que estabas haciedo cuando empezo el dolor?
R 
Radiation [6]
  • El dolor es localizado o se mueve para otro lugar?
A 
Associated [7]
  • Existe otro síntoma asociado?
I 
Increasing factors [2]
  • Existe algo que empeore el dolor?
D 
Decreasing factors [8, 9]
  • Existe algo que alivie el dolor?
P 
Previous episode
  • Algun episodio similar en el pasado?
M 
Medications [10]
  • Alguna medicina alivio tu dolor en el pasado?
B 
Bilateral [1]

உங்களுக்கு எந்த இடத்தில் வலி உள்ளது என்று சுட்டிக்காட்ட முடியுமா?

B Base
Cannot feel your base [3]

உங்கள் வலியின் அளவை கீழ்வரும் அளவுகோலில் (1 to 10) வகைப்படுத்த முடியுமா?

B 
Bowel and Bladder Incontinence [1]

இந்த வலி எவ்வளவு நாளாக இருந்து கொண்டிருக்கிறது?

A 
Anesthesia [1]

எப்போது ஆரம்பித்தது?

S 
Sciatica [4]

வலியின் அறிகுறியை விளக்கமாக கூறவும்

E 
Erection [4]

எந்த நேரத்தில் இதை கவனித்தீர்கள்?
காலை, மாலை, இரவு வலியின் அறிகுறிகள் மாறுகிறதா?

S 
Sensory disturbance [1]

நீங்கள் என்ன செய்து கொண்டிருக்கும் போது இந்த வலி வந்தது?

F 
Fracture [5]

இந்த வலி வேறு இடங்களுக்கு பரவுகிறதா?

I 
Infection or IV Drug USE [6]

வேறு இணைந்த அறிகுறிகள் மற்றும் பிரச்சனைகள் இருக்கிறதா?

R 
Ruptured AAA [7]

எது வலியை மோசமாக்குகிறது?

S 
Sciatica [4]

எது வலியை குறைக்கிறது?

T 
Trauma or Tumor [8, 9]

இதற்கு முன் இந்த வலி வந்துள்ளதா?

WWalk
If you cannot even walk, Admit! [9]

இதற்குமுன் வலிக்காக மருந்து சாப்பிட்டதால் ஏதேனும் பலன் ஏற்பட்டதா?

Reference

  • Spector LR, Madigan L, Rhyne A, Darden B, 2nd, Kim D. Cauda equina syndrome. J Am Acad Orthop Surg. 2008;16(8):471-9.
  • Todd NV. An algorithm for suspected cauda equina syndrome. Ann R Coll Surg Engl. 2009;91(4):358-9; author reply 9-60.
  • Fairbank J, Mallen C. Cauda equina syndrome: implications for primary care. Br J Gen Pract. 2014;64(619):67-8.
  • Gardner A, Gardner E, Morley T. Cauda equina syndrome: a review of the current clinical and medico-legal position. Eur Spine J. 2011;20(5):690-7.
  • Aresti N, Murugachandran G, Shetty R. Cauda equina syndrome following sacral fractures: a report of three cases. J Orthop Surg (Hong Kong). 2012;20(2):250-3.
  • Panos G, Watson DC, Karydis I, Velissaris D, Andreou M, Karamouzos V, et al. Differential diagnosis and treatment of acute cauda equina syndrome in the human immunodeficiency virus positive patient: a case report and review of the literature. J Med Case Rep. 2016;10:165.
  • Engamba SA, Garaleviciene D, Baldry J. Contained ruptured abdominal aortic aneurysm presenting as cauda equina syndrome. BMJ Case Rep. 2017;2017.
  • Singh H, Rao VS, Mangla R, Laheri VJ. Traumatic transverse fracture of sacrum with cauda equina injury--a case report and review of literature. J Postgrad Med. 1998;44(1):14-5.
  • Wada S, Matsuo R, Matsushita T, Fukushima Y, Ago T, Kitazono T. [Intravascular Large B Cell Lymphoma with Cauda Equina Syndrome: A Case Report and Review of the Literature]. Brain Nerve. 2016;68(1):97-101.
ABOUT

I started my medical career in 1995 when I joined KMC, Manipal, one of the prestigious institutions in India. KMC, Manipal is in Karnataka,and people speak Kannada and Tulu. I remember the lecture in medical school when our professor explained the importance of integrating communication skills with the clinical skills. He emphasized the need to learn the local language. India is a diverse country with many languages and dialects. Our professor asked us a straightforward question, if we cannot understand the patient’s pain, then how will we treat it. He explainedthe difference between a symptom and a sign and made a funny acronym to describe the characteristics of both. Read More...

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