Neurological Emergencies—What do you do now?

Do you send him home with a foley and a leg-bag, MR next week, see the neurosurgeon the week after? That would be typical treatment for a lumbar disc. So what's different?

The bladder function is different. Since the sphincters are tremendously redundantly innervated, to show neurologica dysfunction one must have lost > 90% of innervation.

This is a SURGICAL EMERGENCY.

He needs an MR NOW and a neurosurgery consult NOW.

If the disc can be removed within 24 h of rupturing, normal or near-normal sphincter function can occur. If one waits >24 h to operate and decompress these nerves, then a high probability of permanent sphincter dysfunction exists. There are few madder people than a young person condemned to a leg-bag needlessly.