Intracranial mimics of Cauda Equina Syndrome: Heads or Tails?

OBJECTIVE: To report cases of extraspinal mimics of cauda equina syndrome (CES) to enable prompt diagnosis and treatment in the future.

BACKGROUND: CES results from compression of spinal nerve roots. Current practice mandates lumbosacral MRI scanning to diagnose CES. However they may not reveal compression or provide an explanation for the presentation. We present three cases of suspected CES who went on to have intracranial pathology.

CASE PRESENTATION: Case 1: A 57 year old lady presented with urinary retention and bilateral leg weakness. She underwent an MRI spine which showed no evidence of CES. She was diagnosed with haemorrhagic intracranial metastases. Case 2: A 52 year old lady presented with lower back and right buttock pain, with right sided leg numbness, saddle hypoaesthesia and bowel and bladder incontinence. MRI spine showed no cauda equina compression. MRI neuraxis revealed a subdural haematoma. Case 3: A 69 year old lady presented with a 6 day history of urinary incontinence, right foot drop and leg weakness. MRI spine was negative for CES. She was diagnosed with an intraparenchymal haematoma of posterior left frontal lobe.

CONCLUSION: Negative lumbosacral MRI will not exclude extraspinal mimics of CES and although rare, these cases should be considered.