From the Guidelines
In cauda equina syndrome, you would typically not have a positive Babinski sign. The Babinski sign is characterized by upward movement of the big toe and fanning of the other toes when the sole of the foot is stimulated, indicating upper motor neuron damage. Cauda equina syndrome affects the lower motor neurons in the cauda equina (the bundle of nerve roots at the end of the spinal cord), resulting in lower motor neuron signs rather than upper motor neuron signs. Some key points to consider in cauda equina syndrome include:
- Saddle anesthesia
- Bowel and bladder dysfunction
- Lower extremity weakness
- Reduced or absent lower extremity reflexes, as noted in a study by Fairbank et al 1 Patients with cauda equina syndrome typically present with these symptoms, and the Babinski reflex would usually be absent or normal (downward toe movement) in cauda equina syndrome because the pathology is below the level of the upper motor neurons. Key characteristics of cauda equina syndrome include:
- Dysfunction of the sacral and lumbar nerve roots within the vertebral canal secondary to cauda equina nerve root compression
- Impairment of the bladder, bowel, or sexual function and perianal or saddle numbness, as described in the study 1 This distinction is important for neurological examination and diagnosis, as the pattern of reflexes and motor responses helps differentiate between upper and lower motor neuron lesions.
From the Research
Cauda Equina Syndrome and Babinski Sign
- Cauda equina syndrome is a condition that occurs when the nerves in the lumbosacral spinal canal are compressed, leading to symptoms such as sensory loss, motor weakness, and bowel and bladder dysfunction 2.
- The diagnosis of cauda equina syndrome is often made based on a combination of clinical presentation, physical examination, and imaging studies such as MRI or CT myelogram 2, 3.
- A positive Babinski sign is a neurological sign that indicates upper motor neuron damage, but its presence or absence in cauda equina syndrome is not specifically mentioned in the provided studies.
- However, it is known that cauda equina syndrome can cause a range of neurological symptoms, including motor weakness and sensory disturbances, which may be related to upper motor neuron damage 4.
- The studies provided focus on the diagnosis, management, and prognosis of cauda equina syndrome, but do not specifically address the relationship between cauda equina syndrome and the Babinski sign 5, 6.
Neurological Examination in Cauda Equina Syndrome
- A thorough neurological examination is essential in the diagnosis and management of cauda equina syndrome 2, 3.
- The examination may include assessment of motor strength, sensation, and reflexes, as well as evaluation of bowel and bladder function 2, 3.
- While the Babinski sign is not specifically mentioned in the provided studies, it is possible that it may be assessed as part of a comprehensive neurological examination in patients with cauda equina syndrome.
- However, without further evidence, it is unclear whether a positive Babinski sign would be a common finding in patients with cauda equina syndrome.