Cauda Equina Syndrome - Identifying The Move From CESI to CESR
With over 20 years experience, Clinical Negligence Solicitor David Dickie, shares his knowledge of Cauda Equina Syndrome (CES) and how to identify the move from CESI to CESR…
In many patients it can be difficult to identify the point at which the patient moves from CESI to CESR. There are some patients who awake to find that the bed is wet or who stand up and are incontinent of urine; in those patients we can get a fairly accurate time of onset of CESR.
However, there are patients who have restricted fluid intake who have not passed urine for many hours, but the bladder scan shows only a small volume of urine in the bladder and in that patient it may be that not passing urine is physiological not pathological. There are real difficulties in establishing a precise moment for the onset of CESR.
Even in medicolegal practice where there is careful review of the medical and nursing records, charts and witness statements from the patient and family we can often do no better than offer a range of times during which CESR probably occurred. In other patients the bladder is catheterised because of painful retention of urine. Once catheterised the moment of painless retention of urine with incontinence cannot be identified. In the catheterised patient a catheter tug can be used to see if there is bladder neck sensation. The catheter is retained in the bladder with a balloon (inflated with saline). If the external part of the catheter is tugged the balloon descends into the bladder neck and if this is painful the assumption is that there is retained bladder sensation which means that the patient is not CESR.
We also need to consider what volume of urine is drained from the bladder following catheterisation. Where there is painful retention we would normally expect there to be 500-800 mls of urine in the bladder. We can make the assumption therefore that if more than 500 mls of urine is drained from the bladder and there had been no pain or sensation of bladder fullness at the time of catheterisation the patient was in painless urinary retention which is CESR.
How We Can Help
Cauda Equina syndrome claims are technically complicated and it is therefore important to instruct an expert, such a David, to pursue your claim. By dealing with each claim personally, from start to finish, on a no win, no fee basis, not only will he successfully maximise your prospects of success, but also the amount of damages you obtain. David is a member of Action for Victims of Medical Accidents’ (AvMA ) Clinical Negligence Panel, who has over 30 years of experience specialising in litigating cauda equina syndrome claims.
David Dickie, is renowned both for achieving many high value settlements of Cauda Equina Syndrome claims and for his client empathy. He can be contacted on freephone 0800 011 6666 or via email at d.dickie@timms-law.com
