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Outline of Discussion
Introduction Anatomical Overview Conus Medullaris Syndrome Trauma As An Etiology Cauda Equina Syndrome Questions
Introduction
Conus medullaris and cauda equina syndromes are clinical entities
Diagnosis based on clinical findings
History and Physical Examination
Etiology is variable
Introduction
Whats the Difference?
Idealistically
Patients with conus medullaris syndrome typically present with symptoms consistent with:
Spinal cord compression Spinal cord dysfunction Intrinsic pathology
Patients with cauda equina syndrome typically present with symptoms consistent with:
Lumbosacral radiculopathies Extrinsic pathology
Practically
There is much overlap in symptomatology Both require complete evaluation, including imaging, to manage appropriately
Anatomical Overview
For Zak For Bong Soo
Anatomical Overview
Trauma As An Etiology
Trauma As An Etiology
Acute Spinal Cord Injury Syndromes in Trauma Patients
Complete spinal cord injury
ASIA/IMSOP Grade A Unilevel: no zone of partial preservation Multiple level: zone of partial preservation
ASIA/IMSOP Grades B, C, and D Cervicomedullary syndrome Central cord syndrome Anterior cord syndrome Posterior cord syndrome Brown-Squard syndrome Conus medullaris syndrome ASIA/IMSOP Grade A ASIA/IMSOP Grade B, C, and D Cord concussion Burning hands syndrome Contusio cervicalis Hysteria
Trauma As An Etiology
Conus Medullaris Syndrome: Trauma Definition
Combination of upper and lower motor neuron deficits, with initial flaccid paralysis of the legs and anal sphincter
Trauma As An Etiology
Conus Medullaris Syndrome: Trauma Symptoms
Acute Phase
Flaccid paralysis of the legs Paralysis of the anal sphincter
Chronic Phase
Muscle atrophy of the legs Lower extremity spasticity Lower extremity hyperreflexia
Extensor plantar response may be present
What about a central disc herniation at L5-S1 sparing the motor and sensory roots of the lower extremities but affecting bowel and/or bladder function? The frequency of daily urination is much greater than bowel evacuation, so
Presently
Bladder dysfunction with a decrease in perianal sensation
Questions
Please give two etiologies of conus medullaris and/or cauda equina syndrome Please recall the most common location for the end of the spinal cord in the adult human