Local and regional anaesthesia: cauda equina syndrome after continuous spinal: practice question

A Anaesthesia 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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Anaesthesia · Local and regional anaesthesia: cauda equina syndrome after continuous spinal

Sample item

After continuous spinal anaesthesia through a microcatheter with repeated doses of hyperbaric 5 percent lignocaine, a patient develops bladder and bowel incontinence, saddle numbness and patchy leg weakness. What is the most likely mechanism?

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

The answer and the reasoning

A. Neurotoxicity from pooling of concentrated local anaesthetic around the sacral roots

Maldistribution and pooling of concentrated hyperbaric lignocaine around the cauda equina through small-bore catheters caused permanent neurological injury, and led to the withdrawal of such catheters. Haematoma and arterial insufficiency are different causes that present with other time courses.

Option by option

  • A. Neurotoxicity from pooling of concentrated local anaesthetic around the sacral roots (correct)

    Correct. Pooled concentrated drug is directly neurotoxic to the sacral roots.

  • B. Bacterial meningitis

    Meningitis presents with fever and meningism.

  • C. Anterior spinal artery syndrome

    Anterior spinal artery syndrome spares dorsal column sensation, unlike saddle numbness.

  • D. Spinal epidural haematoma

    Haematoma presents with severe back pain and progressive deficit, usually in anticoagulated patients.

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 Anaesthesia question

What is the answer to this Anaesthesia question?

The best answer is A, Neurotoxicity from pooling of concentrated local anaesthetic around the sacral roots. Maldistribution and pooling of concentrated hyperbaric lignocaine around the cauda equina through small-bore catheters caused permanent neurological injury, and led to the withdrawal of such catheters.

Why is "Bacterial meningitis" not the answer?

Meningitis presents with fever and meningism.

Why is "Anterior spinal artery syndrome" not the answer?

Anterior spinal artery syndrome spares dorsal column sensation, unlike saddle numbness.

Why is "Spinal epidural haematoma" not the answer?

Haematoma presents with severe back pain and progressive deficit, usually in anticoagulated patients.

What concept does this question test?

It tests Local and regional anaesthesia: cauda equina syndrome after continuous spinal in Anaesthesia. Haematoma and arterial insufficiency are different causes that present with other time courses.

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 Local and regional anaesthesia: cauda equina syndrome after continuous spinal?

Make a table of each agent, its key advantage and its main side effect. Then use the flashcards and the other Anaesthesia 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.