A delayed diagnosis of cauda equina syndrome (CES) can have life-changing consequences. At Switalskis our specialist medical negligence team is representing a woman in an ongoing negligence claim after healthcare professionals allegedly failed to recognise the warning signs of CES.

While liability is disputed and the claim remains ongoing, the case highlights why recognising the red flag symptoms of cauda equina syndrome and acting quickly is so important.

How Switalskis is supporting a client after delayed diagnosis of cauda equina syndrome

Switalskis’ medical negligence specialist, Chris Gresswell-Green is currently representing a woman in her early 40s in an ongoing medical negligence claim involving healthcare professionals in Lincolnshire.

The claim concerns whether opportunities were missed to recognise the warning signs of cauda equina syndrome and arrange urgent investigation before permanent neurological damage occurred.

Cases of this nature can arise across a range of healthcare settings. Patients in Lincolnshire are often initially assessed by GPs, NHS111 clinicians, urgent treatment centres, physiotherapists, osteopaths and hospital teams before a diagnosis of cauda equina syndrome is made. This case highlights the importance of recognising potential red flag symptoms at every stage of a patient's journey through the healthcare system.

Cauda equina syndrome (CES) is a rare but serious condition caused by compression of the bundle of nerves at the base of the spine. It is a medical emergency because, without prompt diagnosis and treatment, it can lead to permanent damage affecting bladder, bowel and sexual function, as well as mobility and sensation in the legs.

Early diagnosis is crucial. Emergency surgery performed before permanent nerve damage occurs can significantly improve a patient's long-term outcome.

Although not everyone with back pain has cauda equina syndrome, healthcare professionals should remain alert to symptoms that may indicate the condition.

How cauda equina syndrome symptoms can evolve

Our client's experience illustrates how cauda equina syndrome may develop over several days.

She initially sought medical advice after developing severe lower back pain and pain radiating into her right leg. Disc pathology was suspected and she underwent a series of consultations with different healthcare professionals as her symptoms evolved over the following days.

A key issue in the claim is whether she should have been provided with clear advice about the red flag warning signs that required urgent medical attention if her symptoms changed.

Over the following days, concerns arose regarding changes in bladder function together with progressive neurological symptoms. As the clinical picture evolved, symptoms included:

• difficulty passing urine
• increasing numbness in her leg
• altered saddle sensation
• progressive weakness in her lower limbs.

During this period, she sought help from NHS 111, another GP, an osteopath and an urgent care practitioner.

The claim is examining whether opportunities were missed to recognise the developing signs of cauda equina syndrome and arrange emergency hospital assessment.

Eventually, MRI imaging identified a large L5/S1 disc prolapse compressing the cauda equina, and our client underwent emergency decompression surgery.

What are the red flag symptoms of cauda equina syndrome?

Cauda equina syndrome can present in different ways and symptoms may develop gradually rather than appearing all at once.

Symptoms that may require urgent medical assessment include:

• difficulty starting urination or changes in normal bladder function;
• loss of sensation when passing urine;
• urinary retention or incontinence;
• altered sensation around the genitals, buttocks, inner thighs or back passage;
• bowel dysfunction, including loss of control or altered sensation;
• increasing weakness, numbness or sensory disturbance in one or both legs;
• severe back pain accompanied by sciatica.

Anyone experiencing symptoms suggestive of cauda equina syndrome should seek urgent medical advice.

Why urgent MRI and spinal assessment matter

One of the key issues in many delayed diagnosis claims is whether treatment could have been provided before permanent nerve damage occurred.

The claimant's expert evidence supports her case that, had she been referred for urgent MRI and spinal assessment sooner, she would have undergone surgery at an earlier stage of the disease process and avoided the permanent neurological injuries she now experiences.

How cauda equina syndrome symptoms can evolve

Our client has been left with life-changing injuries affecting many aspects of her daily life.

She continues to experience:

• numbness, tingling or altered sensation around the genitals, buttocks, inner thighs and back passage
• difficulty starting urination, reduced bladder sensation, urinary retention and incontinence
• bowel incontinence, constipation and loss of sensation when passing a bowel motion
• sexual dysfunction and reduced genital sensation
• worsening leg weakness, numbness and pain 

She continues to undergo rehabilitation and receives support from specialists in urology, colorectal medicine, occupational therapy and mental health.

Her injuries affect her mobility, independence, sleep, parenting and overall quality of life.

As the claim is ongoing, independent experts continue to assess her future care, rehabilitation and financial needs.

Why delayed diagnosis of cauda equina syndrome claims can be complex

Delayed diagnosis of cauda equina syndrome is often medically complex.

Patients may be seen by several healthcare professionals over a short period of time, with symptoms developing between appointments. Establishing what information was available at each consultation, whether appropriate questions were asked and whether urgent referral should have taken place requires detailed analysis of medical records and independent expert evidence.

In this case, Switalskis has reconstructed our client's clinical pathway across GP appointments, NHS 111, urgent care, osteopathy and hospital treatment to understand how events unfolded. 

Specialist solicitor comment

"Cauda equina syndrome is a medical emergency. One of the recurring themes we see in delayed diagnosis claims is that symptoms often develop gradually and patients may see a number of different healthcare professionals over a short period of time. Recognising red flag symptoms, providing appropriate safety-netting advice and arranging urgent investigation where necessary can make a profound difference to long-term outcomes. Cases of this nature require detailed investigation supported by independent medical experts.”

Chris Gresswell-Green, Specialist Medical Negligence Solicitor at Switalskis

Speak to a specialist cauda equina syndrome solicitor

If you believe you have suffered harm following a delayed diagnosis of cauda equina syndrome, or if you have experienced problems such as bladder dysfunction, bowel dysfunction, saddle numbness or leg weakness that were not investigated promptly, our specialist medical negligence solicitors can advise you on whether you may have a claim.

We act for clients across England and Wales, including those whose care was provided by GP practices, hospitals and other healthcare providers.

Our team can advise whether you may have a claim, explain the medical negligence process and help you secure compensation to fund rehabilitation, care and future support.