Case Study: Delayed Diagnosis of Cauda Equina Syndrome Leads to Permanent Neurological Damage

Gerard, 41 years old, Ashford - £110,000

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JMW has helped a man obtain a £110,000 after doctors continually failed to correctly diagnose cauda equina syndrome which has led to permanent neurological damage that could have been prevented if it was spotted earlier.


Gerard had a long history of lower back pain and had attended an osteopath as well as his GP on a number of occasions. He had become depressed since the recent death of his partner.

Sent home by GP

On one occasion he consulted his GP with lower back pain and was seen by a locum who examined him and reported ‘on and off warm sensation around private parts’. An X ray was ordered, which showed osteoarthritic changes and narrowing of L4/5.

Diagnosis missed by osteopath

2 days later, Gerard consulted his osteopath, by which time he was beginning to experience some neurological symptoms, such as tingling around the genitals and a constant urge to pass urine. The osteopath advised him to attend A&E if his symptoms got any worse.

Discharged from walk-in centre

Two days later Gerard attended the walk- in centre at his local hosptial as his back pain was no better. He was seen by an emergency nurse practitioner who referred him to the A&E department of the same Trust which was based at a different hospital. He was seen by an A&E doctor later that day. A diagnosis of simple backache was made and he was discharged.

Gerard was not reassured by this diagnosis and returned to his GP the following day but again no thorough examination took place and a diagnosis of unspecified backache was made.

Return to hospital and eventual diagnosis

Gerard was becoming very anxious about his condition and returned to the A&E department the next day. He was examined by a doctor who recorded ‘numbness and altered sensation down legs plus incontinence of urine. There was a lack of anal tone and loss of perineal sensation.’ An urgent orthopaedic review was sought and he was admitted with a diagnosis of acute cauda equina syndrome (CES).

In the early hours of the next morning Gerard was transferred to a regional hospital where it was noted that he had not passed urine in the previous 24 hours. An urgent MRI scan showed a large posterior disc protrusion at L4/5. That same morning an emergency laminectomy and discectomy was performed.

Permanent damage

Gerard has been left with permanent neurological damage. He has bladder dysfunction requiring self catheterisation and also bowel dysfunction for which he performs rectal irrigation to avoid incontinence. He also has a degree of sexual dysfunction and dense numbness around the buttocks and perineal area. His bladder and bowel symptoms may well get worse as he ages.

Gerard returned to work 2 months after surgery and manages to do his job quite well, but he has not been able to form any kind of relationship since the injury. Not surprisingly, he suffered an adjustment reaction to his disability for which he has received counselling, with some effect.

The settlement

Supportive evidence was obtained in relation to the actions of the GP and A&E doctor in failing to examine Gerard adequately.

JMW Solicitors secured £110,000 for Gerard in full and final settlement.

Have you also suffered permanent damage from a missed diagnosis?

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