EpistemisSaddle anesthesia
Specialty: Neurology.
Why it occurs
- Caquina equina syndrome (compression of sacral and lower lumbar roots due to massive lumbosacral disc herniation or tumor)
- Critical stenosis of the lumbar canal at a low level
- Severe pelvic or lumbar trauma with displaced fracture
- Myelitis of the conus medullaris (terminal inflammatory or infectious lesion of the spinal cord)
- Lumbar epidural abscess or compressive epidural hematoma after lumbar puncture or epidural anesthesia
Initial workup
Emergency lumbosacral magnetic resonance imaging (MRI) (immediate choice study); if not available, CT of the lumbosacral spine with sagittal reconstruction; Bedside bladder ultrasound to evaluate postvoid residual and identify silent urinary retention.
red flags
Loss of sensation in the perineum ("saddle") of sudden or progressive onset associated with recently established fecal or urinary incontinence, urinary retention with painless bladder balloon or progressive bilateral weakness for plantar or dorsiflexion of the foot. It constitutes an absolute neurosurgical emergency.
Standard management
- Emergency decompressive surgical treatment (laminectomy) ideally before 24-48 hours from the onset of symptoms
- Dexamethasone — 10-16 mg intravenous intake in case of tumor or metastatic etiology to reduce perilesional edema
- Multimodal analgesia with opioids if there is associated severe radicular pain.
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Neurology
- Listed causes
- 5
- Treatment options
- 3