Neurology: cauda equina syndrome: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Neurology: cauda equina syndrome

Sample item

A 40-year-old man with low back pain and sciatica develops urinary retention with overflow incontinence, numbness around the perineum, weakness of both legs and reduced anal tone. What is the best next step?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Emergency MRI of the lumbosacral spine for urgent surgical decompression

Saddle anaesthesia, retention and bilateral leg weakness indicate cauda equina compression, most often from a massive central lumbar disc prolapse. This is a surgical emergency in which outcome depends on early decompression, ideally within 24 to 48 hours. MRI is the imaging of choice and should not be delayed.

Option by option

  • A. Oral NSAIDs with review in two weeks

    Conservative analgesia risks permanent sphincter and motor loss.

  • B. Emergency MRI of the lumbosacral spine for urgent surgical decompression (correct)

    Urgent MRI confirms compression and allows prompt decompression to preserve bladder, bowel and sexual function.

  • C. Plain lumbosacral radiographs and physiotherapy

    Plain films cannot show neural compression and delay definitive care.

  • D. Outpatient nerve conduction study

    Electrodiagnostic testing is slow and not part of emergency assessment.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is B, Emergency MRI of the lumbosacral spine for urgent surgical decompression. Saddle anaesthesia, retention and bilateral leg weakness indicate cauda equina compression, most often from a massive central lumbar disc prolapse.

Why is "Oral NSAIDs with review in two weeks" not the answer?

Conservative analgesia risks permanent sphincter and motor loss.

Why is "Plain lumbosacral radiographs and physiotherapy" not the answer?

Plain films cannot show neural compression and delay definitive care.

Why is "Outpatient nerve conduction study" not the answer?

Electrodiagnostic testing is slow and not part of emergency assessment.

What concept does this question test?

It tests Neurology: cauda equina syndrome in General Medicine. This is a surgical emergency in which outcome depends on early decompression, ideally within 24 to 48 hours. MRI is the imaging of choice and should not be delayed.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Neurology: cauda equina syndrome?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.