Cauda equina syndrome — MCCQE Part 1 MCQ

Correct answer: D — Arrange emergency MRI and urgent spine surgery consultation

Arrange emergency MRI and urgent spine surgery consultation is best because urinary retention and saddle anaesthesia are cauda equina red flags. Treat with topical therapy only despite systemic or red-flag features is suboptimal because local treatment alone is inadequate when systemic disease is possible; Delay assessment for several months is suboptimal because red-flag musculoskeletal or dermatologic presentations require timely assessment; Use antibiotics for every presentation is suboptimal because many rashes and painful joints are inflammatory, malignant or mechanical rather than bacterial; Provide opioids or reassurance as the sole management is suboptimal because symptom relief alone does not address diagnosis, function or safety. This is a time-critical diagnosis even if motor power is partly preserved.

Reference: Canadian spine surgery guidance