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Cauda equina syndrome — RCPSC EM MCQ

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HardNeurological emergenciesCauda equina syndromeRCPSC EM

CTAS 2: A 46-year-old has severe low back pain after lifting and now reports urinary retention. Vitals are normal. Exam shows saddle anaesthesia, reduced anal tone and bilateral S1 weakness. Bladder scan shows 850 mL post-void residual. What is the most appropriate investigation?

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Correct answer: E — Urgent MRI lumbar spine

Urinary retention, saddle anaesthesia and neurologic deficits suggest cauda equina syndrome. Urgent MRI and spine surgery consultation are required.

Reference: Canadian spine emergency practice; Royal College EM Objectives