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Cauda equina syndrome — SCE Acute Medicine MCQ

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HardAcute Neurological PresentationsCauda equina syndromeSCE Acute Medicine

A 67-year-old man presents with acute neurological symptoms. Relevant history includes vascular, infectious or neuromuscular risk factors. On assessment, neurological examination shows focal or global dysfunction. Investigations show urinary retention, saddle anaesthesia and bilateral sciatica. What is the most appropriate investigation?

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Correct answer: E — Emergency MRI lumbosacral spine

The key discriminator is that urinary retention, saddle anaesthesia and bilateral sciatica, which makes Emergency MRI lumbosacral spine the single best answer. Serial high-sensitivity troponin is less appropriate because it does not address the dominant acute risk in the vignette; CT pulmonary angiography would fit a different presentation or later stage of care. Diagnostic aspiration with ultrasound guidance and MRI spine are suboptimal because they would either delay time-critical treatment or follow the wrong acute pathway. Teaching point: SCE-style acute medicine questions usually test prioritisation using physiology, timing and a guideline-defined threshold, rather than isolated factual recall.

Reference: https://cks.nice.org.uk/#acute-medicine-order-33-1