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Images in Neurology
July 2014

The Saddle and the Horse’s Tail: Cauda Equina Syndrome

Author Affiliations
  • 1Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium
  • 2Department of Neurosurgery, Medisch Spectrum Twente, Enschede, the Netherlands
JAMA Neurol. 2014;71(7):914-915. doi:10.1001/jamaneurol.2013.6008

The cauda equina syndrome is a clinical diagnosis usually requiring immediate surgical treatment to prevent long-lasting neurological sequelae. A 33-year-old woman with a 2-week history of left-sided leg pain and perianal hypoesthesia was referred to us when urinary retention and fecal incontinence developed. The clinical diagnosis of cauda equina syndrome was made. Imaging revealed an intraspinal mass filling up the entire spinal canal at the L5-S1 level (Figure 1).