Epidural Haematoma — FRCA Final MCQ

Instant feedback + full explanation. One question, done properly.

ModerateRegional AnaesthesiaEpidural HaematomaFRCA Final

A 52-year-old man has a lumbar epidural sited at L3/4 for postoperative analgesia following major abdominal surgery. Eight hours later, having previously had normal leg power, he develops severe lower back pain, progressive bilateral leg weakness (grade 2/5) and urinary retention. What is the most urgent investigation?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: D — MRI of the lumbar spine

The correct answer is **A: MRI of the lumbar spine**. New progressive bilateral weakness, urinary retention and severe back pain during postoperative epidural analgesia strongly suggest a vertebral canal haematoma causing cauda equina or cord compression. This is a time-critical neurosurgical emergency: MRI provides the best definition of the haematoma, its extent and neural compression, while urgent neurosurgical involvement proceeds concurrently. RCoA NAP3 emphasises urgent spinal MRI and reports the best prospect of neurological recovery when evacuation occurs within 8 hours of symptom onset. CT may be considered only if MRI is genuinely unavailable or contraindicated and must not cause delay. Plain radiography cannot demonstrate epidural soft-tissue compression. Nerve conduction studies assess peripheral neurological dysfunction and are inappropriate acutely. Lumbar puncture is non-diagnostic and potentially hazardous in suspected spinal canal compression.

Reference: Royal College of Anaesthetists. NAP3: Major Complications of Central Neuraxial Block in the United Kingdom, Chapter 7 and Appendix 3, 2009. https://www.rcoa.ac.uk/sites/default/files/documents/2019-09/NAP3%20report.pdf