Cauda equina syndrome in a patient with prolonged immobilization and hemostasis disorders: A case with spinal epidural hematoma complications

Background: Cauda equina syndrome (CES) is a neurological emergency that requires prompt diagnosis and intervention to prevent long-term complications. This condition is often caused by compression of the cauda equina structures within the spinal canal. This report aims to highlight the importance of early diagnosis, comprehensive management, and multidisciplinary collaboration in addressing CES cases with complex comorbidities. Case presentation: This report presents the case of a 48-year-old female patient with a history of a motor vehicle accident (MVA), leading to progressive weakness in both lower extremities, culminating in complete motor function loss, accompanied by sensory deficits and urinary dysfunction. The patient also presented with multiple comorbidities complicating the disease course, including prolonged immobilization, mild anemia, chronic hepatitis B, and coagulation disorders. Lumbosacral MRI revealed a hyperacute to acute spinal epidural hematoma at the Th11-L5 segments, causing grade III spinal canal stenosis and compression of the cauda equina. Additional findings included spinal cord edema and impaired cerebrospinal fluid flow. This case illustrates the complex overlap between post-traumatic complications, systemic conditions, and the need for multidisciplinary management. Management in this case involved emergency surgical intervention with multiple laminotomies and evacuation of the epidural hematoma, along with supportive care to prevent further complications. This report highlighted the importance of early diagnosis, comprehensive management, and multidisciplinary collaboration in addressing CES cases with complex comorbidities. Conclusion: The patient’s case highlights the critical nature of CES as a surgical emergency, with timely intervention being essential for optimal recovery.