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Cauda Equina Syndrome — RACP Adult Medicine MCQ

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EasyEmergency MedicineCauda Equina SyndromeRACP Adult Medicine

A 55-year-old man presents with bilateral lower limb weakness, urinary incontinence, and saddle anaesthesia that developed over 24 hours. MRI shows a large central disc prolapse at L4/5 compressing the cauda equina. What is the urgency of management?

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Correct answer: A — MRI in 6 weeks then decide

Cauda equina syndrome (bilateral leg weakness, saddle anaesthesia, bladder/bowel dysfunction) is a surgical emergency requiring urgent decompression ideally within 24 hours (and definitely within 48 hours). Delay in surgical decompression is associated with permanent neurological deficit, particularly bladder dysfunction. All patients with suspected CES should have emergency MRI and urgent neurosurgical/spinal surgical consultation. The clinical features must be clearly communicated to the surgical team.

Reference: eTG – 2025 – Neurology; NICE – 2023 – Spinal Emergency Guidelines