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Cauda equina syndrome — RCPSC EM MCQ

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ModerateNeurological emergenciesCauda equina syndromeRCPSC EM

A 46-year-old man has new urinary retention, saddle anaesthesia, and bilateral sciatica. Power is 4/5 in ankle plantarflexion bilaterally and post-void residual is 620 mL. Temperature is normal and ESR is mildly elevated. What is the most appropriate investigation?

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Correct answer: E — Urgent MRI lumbar spine

Urinary retention, saddle anaesthesia, bilateral radicular pain, and motor deficit suggest cauda equina syndrome. Urgent MRI is required, with spine surgery involvement.

Reference: Canadian spine emergency practice; neurosurgical consensus