The EM Educator Series: My Patient with Unilateral Leg Weakness

Author: Alex Koyfman, MD (@EMHighAK) // Edited by: Brit Long, MD (@long_brit) and Manpreet Singh, MD (@MprizzleER)

Welcome back to the EM Educator Series. These posts provide brief mini-cases followed by key questions to consider while working. The featured questions provide important learning points for those working with you, as well as vital items to consider in the evaluation and management of the specific condition discussed.

This week has another downloadable PDF document with questions, links and answers you can share with learners as educators in #MedEd. Please message us over Twitter and let us know if you have any feedback on ways to improve this for you. Enjoy!

Case 1:

A 41-year-old female with a history of obesity and chronic back pain presents with worsening back pain and bilateral sciatica. Upon further questioning, she states her urine output is “different”, and she has been unable to feel when she wipes were perineal area with toilet paper.

Case 2:

A 52-year-old male presents with worsening back pain. He has noticed issues with erectile dysfunction within the past 48 hours. He has not noted any changes in urine or bowel function. On neurological exam, he has bilateral weakness with L5 function.


  • What are the emergent causes of low back pain?
  • What other systems besides musculoskeletal can cause back pain?
  • What are key components of the history in patients presenting with back pain?
  • What comprises a complete neurological exam for a patient with back pain?
  • How can cauda equina syndrome present?
  • How should you evaluate for cauda equina syndrome, including ED testing?
  • What is the management of cauda equina syndrome?
  • What imaging does my back pain patient need?


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