a. History: Fecal incontinence

b. MRI: Spinal Stenosis 

Next Pivotal Assessment	Finding
MRI*	severe spinal stenosis	disc herniation	tumor, infection, or trauma.

 

A patient presenting with back pain and fecal incontinence raises concern for cauda equina syndrome (CES), a neurosurgical emergency. The best initial test to order is:

MRI of the Lumbar Spine (with and without contrast if infection or malignancy is suspected)

• MRI is the gold standard for diagnosing cauda equina syndrome, which can result from severe spinal stenosis, disc herniation, tumor, infection, or trauma.

2. Emergent Neurosurgical Consultation
   • If CES is suspected, immediate surgical decompression is needed.

Time is critical—delayed diagnosis and treatment can result in permanent neurological deficits.

Management and Determining the Cause