Neurogenic Bladder Dysfunction with Intact Bladder Sensation
Cerebrovascular accident (CVA) is most characteristically associated with neurogenic bladder dysfunction with intact bladder sensation, presenting as detrusor overactivity with preserved sensory awareness.
Understanding the Neuroanatomical Basis
The key to answering this question lies in understanding which neurological lesions preserve bladder sensation while disrupting bladder control:
Upper Motor Neuron Lesions (Suprapontine)
- CVA and other suprapontine lesions typically preserve bladder sensation because sensory pathways remain intact while voluntary control mechanisms are disrupted 1
- These patients characteristically experience detrusor overactivity with awareness - they feel the urge to void but cannot inhibit bladder contractions 2
- Pelvic floor muscle training is specifically recommended for patients with multiple sclerosis or cerebrovascular accident to improve urinary symptoms, indicating preserved sensation allows for voluntary muscle control 2
Lower Motor Neuron Lesions (Loss of Sensation)
In contrast, the other options typically result in impaired or absent bladder sensation:
Cauda equina lesions produce lower motor neuron dysfunction with characteristically impaired perineal sensation and often progress to a "paralysed, insensate bladder" 2
Cauda equina syndrome with retention (CESR) specifically involves neurogenic retention with an insensate bladder 2
Electrophysiological studies show that cauda equina lesions at L3 or below typically cause detrusor underactivity or acontractility with sensory loss 3
Myelomeningocele causes sacral and lower spinal cord malformations with universal bowel and bladder dysfunction, where sensation is curiously spared in legs but bladder sensation is typically impaired 2
Paraplegia (spinal cord injury) involves suprasacral spinal lesions that typically disrupt both motor and sensory pathways, resulting in impaired bladder sensation 1
Nerve injury with abdominoperineal resection represents peripheral nerve damage causing lower motor neuron dysfunction with both motor and sensory deficits 4
Clinical Distinction
The critical distinguishing feature is:
- Suprapontine lesions (CVA): Detrusor overactivity + intact sensation = urgency with awareness 2
- Cauda equina/peripheral lesions: Detrusor underactivity/acontractility + impaired sensation = retention without awareness 2, 3
Therefore, the answer is (e) cerebrovascular accident, as it represents the prototypical suprapontine upper motor neuron lesion that disrupts voluntary bladder control while preserving the sensory pathways necessary for bladder awareness.