Case report of missed evolving cauda equina syndrome: pitfalls to avoid in remote consultations

Abstract

A 44-year-old lady presented with complaints of lumbosacral back pain radiating to the front of both thighs and up to the front of both knees. She was offered Teleconsultation by 2 GPs and was treated with analgesics. But her pain was not relieved. The third GP took a detailed history and elicited the red flags pointing towards a cauda equina syndrome (CES) in progression. She was called for examination and then was referred to the specialist for immediate further investigations and action. She underwent surgery for CES and her recovery was uneventful. Teleconsultation has the chief limitation of not being able to examine the patient. The importance of taking a detailed clear history regarding the symptoms of cauda equina and documenting the presence or absence of each of the red flag symptoms cannot be overemphasised. Clear, candid and honest discussion of the concerns of the symptoms and the rationale for the referral to the spinal surgeon must be discussed with the patient so as to prevent any miscommunication which can lead to medicolegal claims later on.