Red flags
- Saddle anaesthesia
- Urinary retention or incontinence
- Faecal incontinence
- Bilateral leg weakness/sciatica
First steps
- Neurological + PR examination (anal tone, saddle sensation)
- Bladder scan (post-void residual)
- Urgent MRI L-spine within hours
Key investigations
- MRI L-spine (definitive)
- CBC, ESR (exclude infection)
Differentials
- Conus medullaris syndrome
- MS relapse
- Transverse myelitis
Initial management
- Urgent neurosurgical decompression within 48 h (ideally <24 h)
- Catheterise if retention
Referral
- Neurosurgery immediately
AI clinical assessment
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