Which finding is a red flag suggesting possible cauda equina syndrome?

• A. Normal neurological exam.
• B. Headache.
• C. Shortness of breath.
• D. Cauda equina symptoms.

Answer: (D)

Cauda equina syndrome is an emergency caused by compression of the lower-spine nerve roots, and the red flags are signs that point to that problem. The hallmark clues are involvement of the saddle area and loss of bladder or bowel control—think saddle anesthesia, urinary retention or incontinence, fecal incontinence, and reduced anal sphincter tone—often with bilateral leg weakness. These findings require urgent MRI and surgical decompression to prevent permanent damage. Among the options, only symptoms affecting the cauda equina directly indicate this syndrome. A normal neurological exam isn’t a red flag for CES, and headache or shortness of breath are unrelated to this condition.