Cauda equina syndrome (CES) is a rare clinical entity with an incidence of two per million people annually [1]. Symptoms and signs are very variable. Amongst them are severe low back pain, bilateral or unilateral sciatica, saddle anaesthesia, motor weakness, sensory deficit, and bladder and bowel dysfunction [1, 2]. None of these features has a high predictive value for CES in its own right, and many are common complaints with a variety of possible causes [3]. A high level of suspicion for CES is needed in any clinician who may come across it. Unfortunately, CES is all too often mis-managed [4, 5], resulting in not only devastating consequences for the patient’s quality of life, but also a disproportionately high medico-legal profile and significant risk of litigation [3, 6]. CES is a true spinal surgical emergency which, if untreated, may progress to paraplegia and/or permanent incontinence [2]. Debate as to the optimum timing for decompressive surgery, where cauda equina compression is the cause, is ongoing [2, 7], but prompt diagnosis is mandatory. Although magnetic resonance imaging (MRI) scanning is the diagnostic tool of choice [3], the percentage of patients being scanned for a clinical diagnosis of CES and in whom a compressive lesion is found on imaging is only 22 % [8]. It is important, therefore, to keep an open mind as to the aetiology of the patient’s symptoms. A thorough history and examination should underpin the diagnostic process and should guide further investigation, particularly in those patients whose lumbar spine MRI scans are unremarkable. We present two cases of aortic occlusion mimicking compressive CES that presented to our unit.