Playlist 'educational cases' by Dr Sepehr Haghighi

Images
Questions
Findings

What surgical emergency needs to be excluded?

You must exclude cauda equina syndrome (CES). The normal saddle sensation and bladder function are reassuring, but the compression can progress to irreversible nerve damage if untreated.

Question 2

What modality is best to investigate this?

Show Answer

This patient needs a MRI. This provides information on the position and status of the nerves, as well as the disc, bones and surrounding soft tissues. Although a relatively complex and time-intensive investigation, it is also the only noninvasive way to exclude the above emergency by imaging.

Presentation

Known mild L4/5 disc prolapse - not requiring intervention. Worsening left leg pain and woke with numbness and foot drop. Weak flexors and increased reflexes. Loss of sensation in left L5 distribution. Saddle sensation intact and decent post void volumes.

Patient Data

Age:	35
Gender:	Female

Radiopaedia.org

Patient Data