Using prospectively collected data from their neurosurgical referral center, Dr. Hoeritzauer et al. summarize their observations regarding patients with cauda equina syndrome (CES), with and without imaging confirmation. Among patients in this cohort, 69% lacked radiographic evidence of cauda equina compression and were referred to as “scan-negative” (normal MRI) or “mixed” (root enhancement without cauda compression). History or presence of functional symptoms, along with normal patellar reflexes, more severe pain, and panic attack at presentation were associated with a “scan-negative” condition. It is of interest that disturbances of urine or bowel function were no less common among patients with “scan-negative” CES. Dr. Amelot and colleagues highlight the importance of follow-up and education for patients at risk of CES (e.g., those with pre-existing disk disease). They also suggest that patients with scan-negative CES may be vulnerable to underlying somatization or anxiety over the threat of possible neurologic dysfunction. In response, Dr. Hoeritzauer et al. affirm that even patients with “scan-negative” CES were followed for several years after their initial presentation to evaluate the cause of their symptoms. Furthermore, the investigators maintain the objective of their study was to determine risk factors for “scan-negative” vs “scan-positive” CES, which includes functional neurologic disease, medications, pain, and panic. The investigators have referred clinicians and patients to their fact sheet on “scan-negative” CES for more information. Professor Beucler also emphasizes the clinical presentation of CES typically begins with radicular pain, followed by motor and later bowel or bladder symptoms.