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‘Scan-negative’ cauda equina syndrome: what to do when there is no neurosurgical cause
  1. Ingrid Hoeritzauer1,2,
  2. Biba Stanton3,
  3. Alan Carson1,2,
  4. Jon Stone1,2
  1. 1 Department of Clinical Neurosciences, Royal Infirmary of Edinburgh, Edinburgh, UK
  2. 2 Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
  3. 3 Department of Neurology, King’s College Hospital, Neuropsychiatry Service, South London & Maudsley NHS Trust, London, UK
  1. Correspondence to Dr Ingrid Hoeritzauer, Department of Clinical Neurosciences, Royal Infirmary of Edinburgh, Edinburgh, UK; Ingrid.hoeritzauer{at}


Suspected cauda equina syndrome is a common presentation in emergency departments, but most patients (≥70%) have no cauda equina compression on imaging. As neurologists become more involved with ‘front door’ neurology, referral rates of patients with these symptoms are increasing. A small proportion of patients without structural pathology have other neurological causes: we discuss the differential diagnosis and how to recognise these. New data on the clinical features of patients with ‘scan-negative’ cauda equina syndrome suggest that the symptoms are usually triggered by acute pain (with or without root impingement) causing changes in brain–bladder feedback in vulnerable individuals, exacerbated by medication and anxiety, and commonly presenting with features of functional neurological disorder.

  • clinical neurology
  • neurogenic bladder
  • neurourology
  • pain
  • neuropsychiatry

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  • Twitter @IngridHoeritza1, @alancarson15, @jonstoneneuro

  • Contributors IH and BS came up with the idea for the paper. JS and AC were involving in writing the article including drafting and editing the document.

  • Funding JS is supported an NRS Career Researcher Fellowship.

  • Competing interests None declared.

  • Provenance and peer review Commissioned. Externally peer reviewed by Jalesh Panicker, London, UK and Arani Nitkunan, London, UK.

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