Examination must be thorough

doi:10.1136/bmj.b1724

Published 29 April 2009, doi:10.1136/bmj.b1724
Cite this as: BMJ 2009;338:b1724

Letters

Cauda equina syndrome

Examination must be thorough

The first 150 words of the full text of this article appear below.

As well as neurological examination of the legs, perianal andperineal sensation should be assessed in cases of suspectedcauda equina syndrome.¹ This may prove challenging in primarycare settings, but it is the safest way of appropriately triagingsuch patients, facilitates referral, and provides a baselinefor specialist doctors. Examination of perianal and perinealsensation and of the anal sphincter is intimate and potentiallyunpleasant, but if a doctor explains why a complete examinationis important, few patients would refuse. The same examinationwill be repeated by the specialist team, but this is not a goodenough reason for not examining the patient in general practiceor in an emergency department because evolving neurologicalsigns may be missed.

Examining both the perianal and perineal areas has been partof our standard assessment of such patients. Perineal hypoaesthesia/anaesthesiamay be a predictor of a poor outcome.² Indeed, complete perinealanaesthesia . . . [Full text of this article]

Angelos G Kolias, core surgical trainee¹, Saurabh Odak, registrar in trauma and orthopaedics², Atul K Tyagi, consultant neurosurgeon³

¹ Ipswich Hospital, Ipswich IP4 5PD, ² Darlington Memorial Hospital, Darlington DL3 6HX, ³ Leeds General Infirmary, Leeds LS1 3EX

angeloskolias@gmail.com