Neurological Signs for Rare but Deadly Accident Injuries

Low back pain is an extremely common problem and presents on a very regular basis to General Practitioners by victims of accidents. Back pain is a challenge because it is so common. It a major cause of physical, psychological and social disability.

Most back pain is simple self-limiting but it is important to recognise worrying presentations.

Definitions of Back Pain

• Most back pain (85-90%) is the so called mechanical low back pain. The symptoms cannot be ascribed to any particular pathology and it is also called uncomplicated or non specific low back pain.

• What is Sciatica? Sciatica is nerve root pain, this is the lay term for pain extending into the leg, buttock, thigh, calf or heel.

• Other causes of back pain can be ascribed to a particular pathology for example infection, tumour, osteoporosis, fracture, radicular syndrome and Cauda Equina Syndrome (CES).

Simple back pain affects those between 30-60 years of age, starting between 30 and 50. First on set of back pain of this range should arouse suspicion of a sinister cause.

Back pain is second only to the common cold as to the cause of lost days at work. In 2005, there was an estimated 4.9 million working days lost per year in the UK due to back pain.

What History Should Be Asked From Someone with Back Pain?

• When did the pain start?
• Was it sudden or gradual in onset?
• Where is it?
• Does it radiate anywhere else?
• Are there any aggravating or relieving factors?
• What is the person’s occupation and do they partake in sport or physically challenging hobbies?

Could it be Cauda Equina Syndrome (CES)?

Cauda Equina Syndrome should be suspected if there is –

• Bladder dysfunction
• Sphincter disturbance
• Saddle anaesthesia
• Lower limb weakness
• Gait disturbance

Clinical diagnosis of Cauda Equina lesion is not easy. Most cases are of sudden onset and progress rapidly within hours or days. It can however evolve slowly and people do not always complain of pain.

What Are the Key Factors in the Presentation of CES?

• Low back pain with bilateral leg pain.
• Low limb motor weakness or sensory deficits.
• Bowel or bladder dysfunction with saddle parasthesia
• Urinary dysfunction
• Bowel disturbance and loss of anal tone and sensation

What Investigations Should Be Done?

The diagnosis of CES is usually confirmed by an MRI scan.

How is Cauda Equina Syndrome Managed?

• A patient should be referred immediately for a neurosurgical opinion.
• A diagnosis of CES will be confirmed or refuted by an MRI scan.
• Treatment is surgery.

What are the Complications Associated with CES?

Complications are increasingly likely if diagnosis and appropriate management is delayed and include –

• Residual paralysis, sensory abnormality.
• Bladder, bowel and sexual dysfunction.

Cauda Equina Syndrome is a very debilitating disease and people who suffer injuries in road and work accidents and who experience or display these symptoms should immediately attend their General Practitioners so that they can referred to a specialist for expert investigations and MRI scanning.

If any of these affect you or if you have received these types of injuries in a road accident or any other type of accident please contact Liam Moloney, Solicitor Naas at 045 898000 to find out about your rights to compensation or simply log onto our website at www.moloneysolicitors.ie for further information.