These nerve roots are particularly susceptible to injury, as they have a poorly developed epineurium. When well developed, as in peripheral nerves, they protect against compressive and tensile stresses. The microvascular systems of nerve roots have a region of relative hypovascularity in their proximal third. Increased vascular permeability and subsequent diffusion from the surrounding CSF supplement the nutritional supply. This property of increased permeability may be related to the tendency toward edema formation of the nerve roots, which may result in edema compounding initial and sometimes seemingly slight injury.
Morbidity is variable, depending on the etiology of the syndrome.
Traumatic CES is not age specific. Atraumatic CES occurs primarily in adults. Examiner can inquire if toilet paper feels different when wiping. Sensory abnormality may be present in the perineal area or lower extremities. Muscle weakness may be present in muscles supplied by affected roots.