• Ashwin Kumaria, Zulfiqar Haider, Arousa Ali, Dilip Pillai, Raj Bommireddy, Antony Bateman, and Harinder Gakhar.
• Department of Neurosurgery, Queen's Medical Centre, Nottingham, United Kingdom. Electronic address: Ashwin.Kumaria@doctors.org.uk.
• World Neurosurg. 2020 Dec 1; 144: e643-e647.

BackgroundTo report cases of extraspinal mimics of cauda equina syndrome (CES) to enable prompt diagnosis and treatment in the future. CES results from compression of spinal nerve roots. Current practice mandates lumbosacral magnetic resonance imaging (MRI) scanning to diagnose CES. However, it may not reveal compression or provide an explanation for the presentation. We present 3 cases of suspected CES who went on to have intracranial pathology.MethodsRetrospective review of all patients presenting with CES-type features who were subsequently found to have causative intracranial pathology over a 6-month period.ResultsThree cases were found, and these are hereby presented.Case PresentationCase 1: A 57-year-old lady presented with urinary retention and bilateral leg weakness. She underwent an MRI spine which showed no evidence of CES. She was diagnosed with haemorrhagic intracranial metastases. Case 2: A 52-year-old lady presented with lower back and right buttock pain, with right-sided leg numbness, saddle hypoesthesia, and bowel and bladder incontinence. MRI spine showed no cauda equina compression. MRI neuraxis revealed a subdural haematoma. Case 3: A 69-year-old lady presented with a 6-day history of urinary incontinence, right foot drop, and leg weakness. MRI spine was negative for CES. She was diagnosed with an intraparenchymal haematoma of posterior left frontal lobe.ConclusionsNegative lumbosacral MRI will not exclude extraspinal mimics of CES and, although rare, these cases should be considered.Copyright © 2020 Elsevier Inc. All rights reserved.

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