QuestionSBA
QuestionChoice
Although an MRI is the imaging modality of choice for the investigation and assessment of cauda equina syndrome, a non-urgent MRI is inappropriate given the emergency nature of the condition. If cauda equina syndrome remains untreated, there is a risk of permanent neurological damage such as leg weakness, sensory changes, and incontinence.
10000479
d
Non-urgent MRI lumbar spine
QuestionChoice
This patient suffers from cauda equina syndrome, which occurs due to compression of the cauda equina lumbosacral nerve roots. This pathology is best assessed with an MRI due to the quality of soft tissue imaging and accurate aetiological assessment. The BMJ states that a CT lumbar spine should only be carried out if an MRI is unavailable or contraindicated.
10000477
b
Urgent CT lumbar spine
QuestionChoice
This answer is incorrect for several reasons. Firstly, MRI lumbar spine is the imaging modality of choice due to superior soft tissue imaging. Secondly, cauda equina syndrome is a neurosurgical emergency and requires urgent investigation and intervention.
10000480
e
Non-urgent CT lumbar spine
QuestionChoice
This patient is suffering from cauda equina syndrome, which is a neurosurgical emergency caused by compression of the cauda equina. This can occur due to disc prolapse, trauma, infection or malignancy. In this patient, bony metastases from his prostatic cancer are the most likely underlying cause. Cauda equina presents with lower back pain, sciatica, urinary and/or faecal incontinence, changes in perineal sensation, and reduced anal sphincter tone. The BMJ states that an urgent lumbar spine MRI is the best imaging modality due to soft tissue detail as well as the ability to examine the spinal canal, allowing accurate assessment of aetiology.
10000476
a
Urgent MRI lumbar spine
QuestionChoice
A spinal radiograph is not an appropriate investigation in the assessment of cauda equina syndrome. Plain radiographs have extremely poor soft tissue image quality and are unlikely to delineate compression of the lumbosacral nerve roots of the cauda equina.
10000478
c
Plain spinal radiograph
Concept
Chapter
2693
3772
Cauda equina syndrome
Topic
145
Orthopaedics
12642
A 71-year-old male presents to the Emergency Department with sudden onset urinary incontinence and pins and needles across his perineum. He also notes a 4-week history of lower back pain. His past medical history includes prostate cancer for which he is currently receiving treatment.

On examination, you identify reduced sensation across his perineum as well as reduced anal tone on digital rectal examination.

Which of the following investigations is most likely to be diagnostic of the underlying condition?
a