Deep venous thrombosis of the lower limbs is the most common vascular disorder in hospital. Although the clinical features are not specific, the most important symptoms are oedema, local tenderness, and pain. Well known complications of deep venous thrombosis are pulmonary embolism and chronic venous insufficiency. Neurological complications are uncommon after deep venous thrombosis.

We report on a patient who presented with an acute cauda equina syndrome, which turned out to be caused by thrombosis of the inferior vena cava.

A 58 year old previously healthy white man presented at the emergency department of our hospital with acute severe low back pain irradiating to both legs. The pain in the legs was severe and was located from the lower half of the upper legs down to the feet. He also had noted decreased strength as well as sensory disturbances of both legs. Spontaneous micturition was not possible.

On physical examination, blood pressure was 110 over 75 mm Hg. Heart, lungs, and abdomen were normal. Peripheral arterial pulsations were present. Both legs were slightly swollen and coloured red to purple and livido reticularis was present. On catheterisation of the bladder, there was no urine retention. Neurological examination showed weakness of both legs …