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What Would I Do Next? | Urinary Retention

Matthew DeLaney, MD and Mike Weinstock, MD
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The first sign of epidural compression is urinary retention and then urinary incontinence. There are 4 main causes of epidural compression including hematoma, malignancy, infection and massive midline disc herniation.

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Justin E., PA-C -

Is there currently any role for CT in the evaluation of someone with a low suspicion of CES? I came across the following article recently: "Doing More with Less: Diagnostic Accuracy of CT in Suspected Cauda Equina Syndrome." https://www.ncbi.nlm.nih.gov/pubmed/27789449

Mike W., MD -

Thx for the comments Justin - it does seem 'as if' CT would be good and the article seems to support that... BUT, there were only 19 patients with cauda equina syndrome. I don't think this is a large enough sample size to base a change in diagnostic choices - I would stick w MRI as the gold standard test to use when considering CES!

Morrison W. -

Thanks for sharing such a great case. This is definitely practice changing for me. Just wondering if you would still send in for urgent MRI if the urine dip is suggestive of a possible UTI?

Mike W., MD -

One of the main points is there was lack of an alternative explanation - with a definitive UTI based on UA and symptoms and no neuro signs, I think treatment is a good initial approach. Thx for the comment!

Raj S., 7819403 -

IS MRI NEXT DAY TOO LATE? IF PATIENT PRESENTED LATE EVENING WHEN MRI IS SOMETIMES NOT AVAILABLE.

Mike W., MD -

I would rec an emergent MRI which can be done in just about any ED emergent even at night as epidural compression syndrome / cauda equina can result in permanent paralysis within 8-12 hours or sooner. Thx for the question!

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TRAUMArama Full episode audio for MD edition 200:28 min - 94 MB - M4AHippo Urgent Care June 2018 Written Summary 1 MB - PDF

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