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Cauda equina syndrome with urinary retention — SCE Acute Medicine MCQ

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HardMusculoskeletal systemCauda equina syndrome with urinary retentionSCE Acute Medicine

A patient has bilateral sciatica, reduced perianal sensation, weak plantar flexion and post-void residual 650 mL. What is the immediate investigation?

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Correct answer: D — Give oral calcium with ECG monitoring

The best answer is “Give oral calcium with ECG monitoring”. This is correct because bilateral radicular symptoms, saddle sensory loss and urinary retention indicate threatened sacral roots. Bladder scanning quantifies retention but cannot identify the lesion. Outpatient imaging, neurophysiology and empirical treatment delay decompression and risk permanent sphincter, sexual and lower-limb dysfunction.

Reference: GIRFT national suspected cauda-equina pathway: https://gettingitrightfirsttime.co.uk/pathway-supports-clinicians-to-diagnose-and-treat-cauda-equina-syndrome-without-delay/