Conus medullaris and cauda equina syndromes nervous. Conus medullaris syndrome radiology reference article. Cauda equina syndrome is considered an incomplete cord syndrome, even though it occurs below the conus, and refers to a collection of symptoms and signs that result from severe compression of the descending lumbar and sacral nerve roots. The compression of these nerve roots can be caused mainly by lumbar disc herniation 45% of all causes. Please share if you have usmle style questions about conus medullaris syndrome, cauda equina syndrome, iv disk herniation. The spinal cord tapers and ends at the level between the first and second lumbar vertebrae in an average adult. The conus medullaris is the end of the spinal cord, which is located in the lower back. Ces cauda equina syndrome the cauda equina consists of peripheral nerves, both motor and sensory, below the level of the conus medullaris and within the spinal canal. Neurosarcoidosis of the conus medullaris and cauda equina.
Mri image shows compression of the distal lumbar and sacral nerve rootles 12. Ismah haron 060820141 leg weakness is flaccid and areflexic not spastic and hyperreflexic 2. Introduction conus medullaris and cauda equina syndromes are clinical entities diagnosis based on clinical findings. See more ideas about cauda equina, cauda equina syndrome and spine health. Conus medullaris syndrome is a collection of signs and symptoms associated with injury to the conus medullaris. Cauda equina syndrome symptoms, treatment and recovery. Spontaneous conus medullaris infarction can occur in healthy individuals and presents as cauda equina syndrome. Conus medullaris syndrome and cauda equina syndrome have similar symptoms and can cause it to be difficult to distinguish between the two.
The aim of surgery is to safely decompress the nerve roots and cauda equina and should be performed by the surgeon. Cauda equina syndrome ces is a rare syndrome that has been. Mar 06, 20 unusual, cauda equina syndrome fr om s pinal st enosis s econdary to s pinal disorders such as anky losing spondylitis, spondylosis, and s pondylolisthesis hav e all been repor ted. Cauda equina syndrome vs conus medullaris syndrome explained. Scribd is the worlds largest social reading and publishing site. Cauda equina syndrome due to lumbar disc herniation. Mar 06, 2018 cauda equina syndrome ces refers to a group of symptoms that occur when nerves in the cauda equina a collection of nerve roots that spread out from the bottom of the spinal cord become compressed or damaged. Patients may present with back pain, unilateral or bilateral leg pain, paresthesias and weakness, perineum or saddle anesthesia, and rectal and or urinary incontinence or dysfunction. The cauda equina is formed by the l2l5, s1s5, and coccygeal spinal nerve roots located in the dural sac. Cauda equina syndrome, on the other hand, is a type of spinal cord injury that involves injury to the bundle of nerves that exit below the spinal cord ending cauda equina. Despite similarities, the two spinal cord injuries often manifest themselves in different ways.
Aug 05, 2014 conus medullaris and cauda equina syndrome as a result of traumatic injuries. Spinal cord infarction is rare and occurs in 12100,000. Cauda equina syndrome ces is a rare but serious neurological condition affecting the bundle of nerve roots at the lower end of the spinal cord. Cauda equina syndrome is a relatively rare condition, comprising around 26% of lumbar disc operations 16, 17, 31, with an incidence in the population thought to be between 1 in 33,000 to 1 in 100,000. Review majority of authors agree that urgent decompression can ip t. Cms is often defined by a symmetric sensory deficits, paralytic bladder incontinence, bowel. We conducted a search of the pubmed database of articles from 2002 to 2011 containing the following keywords. Situated near the first two lumbar vertebrae, the conus medullaris ends at the cauda equina, a bundle of spinal nerves and nerve roots. We present multitechnique imaging findings of congenital, infectious, inflammatory, vascular, and neoplastic involvement of the conus medullaris and cauda equina. The chart below compares and contrasts conus medullaris syndrome and cauda equina syndrome to showcase some of the key differences. It is most commonly caused by an acutely extruded lumbar disc and is considered a diagnostic and surgical. The conus medullaris latin for medullary cone or conus terminalis is the tapered, lower end of the spinal cord. Unlike cauda equina syndrome which will only have lower motor neuron deficits, conus medullaris will have a combination of upper and lower motor neuron involvement 3. This should be a succinct and central reference for the radiologist in evaluating the conus medullaris and cauda equina.
Conus medullaris syndrome cms and cauda equina syndrome ces are wellknown neurological entities. Here, we present a patient who developed recurrent bilateral lower extremity paraplegia secondary to spinal cord infarction 1 day after a successful l45 microdiscectomy in a patient who originally presented with a cauda equina syndrome. The collection of nerves at the bottom of the spinal cord is called the cauda equina because it is said to look like a horses tail. Conus medullaris syndrome cms and cauda equina syndrome ces are complex neurological disorders that can be manifested through a variety of symptoms. The most common causes of cauda equina and conus medullaris syndromes are the following. Jun 14, 2018 patients can present with symptoms of isolated cauda equina syndrome, isolated conus medullaris syndrome, or a combination. Cauda equina syndrome ces is a condition that occurs when the bundle of nerves below the end of the spinal cord known as the cauda equina is damaged. Conus medullaris and cauda equina syndromes nervous system.
The patient described here showed a cauda equinaconus medullaris syndrome with subacutely ascending sensorimotor deficits and sacral autonomic involvement. Conus medullaris and cauda equina syndrome as a result of traumatic injuries. Lesions of the epiconus will affect the lower lumbar roots supplying muscles of the lower part of the leg and foot, with sparing of reflex function of sacral segments. Conus medullaris syndrome after epidural steroid injection. Cauda equina syndrome transient neurologic syndrome cauda equina syndrome ces is a clinical representation of local anesthetic neurotoxicity. Jun 14, 2018 cauda equina syndrome refers to a characteristic pattern of neuromuscular and urogenital symptoms resulting from the simultaneous compression of multiple lumbosacral nerve roots below the level of the conus medullaris see the image below. Cauda equina syndrome and conus medullaris syndrome are rare, with an estimated prevalence of 1 in 30,000 to 100,000 people per year. Conus medullaris syndrome manifest symptoms that are similar to cauda equina syndrome, but the two conditions require different treatment. Cauda equina syndrome refers to a characteristic pattern of neuromuscular and urogenital symptoms resulting from the simultaneous compression of multiple lumbosacral nerve roots below the level of the conus medullaris see the image below. Cauda equina and conus medullaris syndromes clinical. Conus medullaris and cauda equina syndromes online.
The conus medullaris, which is the terminal segment of the adult spinal cord, lies at the inferior aspect of the l1 vertebrae. Internationally, about 10 to 80 people per one million. Although rare, sarcoidosis of the conus medullaris and cauda equina should be considered in the differential diagnosis of flaccid paraparesis, particularly in patients with nondiagnostic evaluations. The segment above the conus is termed the epiconus, consisting of spinal cord segments l4s1. Conus medullaris syndrome is a constellation of signs and symptoms indicating underlying injury to the lower end of the spinal cord at the level of first or second lumbar vertebra in adults conus medullarisconus terminalis. It occurs near lumbar vertebral levels 1 l1 and 2 l2, occasionally lower. Cauda equina syndrome refers to a characteristic pattern of neuromuscular and urogenital symptoms resulting from the simultaneous compression of multiple. Cauda equina syndrome ces is an uncommon but potentially devastating condition caused by compression of the cauda equina in the spinal canal. Conus medullaris and cauda equina syndromes online medical.
Cauda equina syndrome ces is a rare neurologic condition that is caused by compression of the cauda equina. Conus medullaris and cauda equina syndrome as a result of. Conus medullaris syndrome is a constellation of signs and symptoms indicating underlying injury to the lower end of the spinal cord at the level of first or second lumbar vertebra in adults conus medullaris conus terminalis. Cauda equina syndrome ces is a rare but characteristic feature in patients with as that occurs mainly in patients in advanced disease stages. Conus medullaris and cauda equina syndromes free download as powerpoint presentation. Conus medullaris typically produces sudden symptoms on both sides of the body, while cauda equina syndrome usually develops over time, producing uneven symptoms concentrated on one side of the body. Cauda equina syndrome ces refers to a group of symptoms that occur when nerves in the cauda equina a collection of nerve roots that spread out from the bottom of the spinal cord become compressed or damaged. The ce provides innervation to the lower limbs, and sphincter,controls the function of the bladder and distal bowel and sensation to the skin around the bottom and back passage 1. Recognition and referral background cauda equina syndrome ces refers to the simultaneous compression of multiple lumbosacral nerve roots below the level of the conus medullaris, resulting in a characteristic pattern of neuromuscular and urogenital symptoms. The collection of nerves at the bottom of the spinal cord is called the cauda equina because it is. Clinical, neuroimaging, and nerve conduction characteristics. Pathology the conus medullaris lies in close proximity to nerve roots and injury to this region results in combined upper motor neuron and lower motor neuron features. The upper end of the conus medullaris is usually not well defined, however, its.
Conus medullaris syndrome is a secondary form of spinal cord damage resulting from injuries to the lumber. Ces can lead to pain, numbness, and weakness in the lower back, pelvic area and legs. Lumbar stenosis multilevel spinal trauma including fractures15 herniated nucleus pulposus cause of 26% of cases of cauda equina syndrome16, 17, 18 neoplasm, including metastases, astrocytoma, neurofibroma, and meningioma. Cauda equina syndrome and conus medullaris syndrome result from. The most distal bulbous part of the spinal cord is called the conus medullaris, and its tapering end continues as the filum terminale. Spinal cord ischemiainfarct after cauda equina syndrome. Neurourologic findings in conus medullaris and cauda. Lumbar stenosis multilevel spinal trauma including fractures15 herniated nucleus pulposus cause of 26% of cases of cauda equina syndrome 16, 17, 18 neoplasm, including metastases, astrocytoma, neurofibroma, and meningioma. Patients may present with back pain, unilateral or bilateral leg pain, paresthesias and weakness, perineum or saddle anesthesia, and rectal andor urinary incontinence or dysfunction. We describe two patients with spontaneous conus medullaris infarction presenting as acute cauda equina syndrome and their unique electromyography emg findings.
The conus medullaris is the bundled, tapered end of the spinal cord nerves. Epidemiology of conus medullaris and cauda equina syndromes. Cauda equina syndrome ces is a particularly serious type of nerve root problem. Outline of discussion introduction anatomical overview conus medullaris syndrome trauma as an etiology cauda equina syndrome questions. Two patients developed acute low back pain with mild asymmetric paraparesis, loss of perianal sensation and sphincter dysfunction. Cauda equina syndrome is characterized by radiating lowback pain, saddle anesthesia, bowel and bladder impairment, weakness, loss of sensation, and hyporeflexia or areflexia in the lower extremities. Cauda equina and conus medullaris syndromes statpearls. Clinical, neuroimaging, and nerve conduction characteristics of. This is a rare disorder where there is pressure on the nerves at the very bottom of the spinal cord.
Intravascular lymphomatosis presenting as an ascending cauda. The cause is usually a disc herniation in the lower region of the back. It can present as varying degrees of pain or neurologic deficit limited to the lower extremities, and it can create functional deficiencies e. Nov 24, 2016 cauda equina vs conus medullaris syndrome 1. It is assumed that these syndromes are different regarding neurological. Patients can present with symptoms of isolated cauda equina syndrome, isolated conus medullaris syndrome, or a combination. Depending on the extension and site of herniation, iv disc herniation can result in 1. The patient described here showed a cauda equina conus medullaris syndrome with subacutely ascending sensorimotor deficits and sacral autonomic involvement. Pdf the epidemiology of cauda equina and conus medullaris lesions is not well known, and this study aimed to provide further information on this. Although rare, sarcoidosis of the conus medullaris and cauda equina should be considered in the differential diagnosis of flaccid paraparesis, particularly in.
Standards of care for investigation and management of cauda equina syndrome. Cauda equina syndrome genetic and rare diseases information. The term cauda equina horses tail refers to the sheaf of nerve roots which descend within the spinal canal distal to the conus medullaris, the termination of the spinal cord, which is approximately at the l1l2 level williams et al 2003. Jul 19, 2019 conus medullaris syndrome is a constellation of signs and symptoms indicating underlying injury to the lower end of the spinal cord at the level of first or second lumbar vertebra in adults conus medullaris conus terminalis. Dec 31, 2010 cauda equina syndrome is a relatively rare condition, comprising around 26% of lumbar disc operations 16, 17, 31, with an incidence in the population thought to be between 1 in 33,000 to 1 in 100,000. Cauda equina syndrome vs conus medullaris syndrome explained dr. Clinically, these cysts may cause nerve compression symptoms such as irradiating pain and limb numbness. The aim of surgery is to safely decompress the nerve roots. Cauda equina syndrome and conus medullaris syndrome are most common in young men, possibly due to this population group being more. Intravascular lymphomatosis presenting as an ascending. Cauda equina consists of spinal nerves l2l5, s1s5 and the coccygeal nerve. A person with conus medullaris syndrome has symptoms that occur when the nerves in the conus medullaris malfunction. Cauda equina syndrome chris lavy, andrew james, james wilsonmacdonald, jeremy fairbank an understanding of cauda equina syndrome is important not only to orthopaedic surgeons and neurosurgeons but also to general practitioners, emergency department staff, and other specialists to whom these patients present. Pdf epidemiology of cauda equina and conus medullaris lesions.
These symptoms are explained by spinal cord and cauda equina invasions by this particular form of lymphoma. Definitions of traumatic conus medullaris and cauda equina. Consequently, problems with the conus medullaris often affect the cauda equina. Cauda equina syndrome an overview sciencedirect topics. These nerves roots connect the central nervous system and peripheral nervous system. However, the syndrome may also complicate metastatic cancer or a primary neoplasm within or infiltrating the spinal canal. Regardless of the epidemiology, ces is a spinal emergency necessitating quick and effective care to mitigate permanent neurological sequelae. Cauda equina syndrome refers to dysfunction of the cauda equina, the collection of ventral and dorsal lumbar, sacral and coccygeal nerve roots that surround the filum terminale.
Spontaneous conus medullaris infarction is a rare disease. The ultimate cause of ces in as is not completely known, but arachnoiditis. Fiftyseven patients with documented conus medullaris and cauda equina injury underwent neurourologic evaluation consisting of cystometrography cmg, perineal floor electromyography emg, and bethanechol chloride supersensitivity testing bst. Aug 01, 2016 cauda equina syndrome ces is a particularly serious type of nerve root problem. It typically causes back pain and bowel and bladder dysfunction, spastic or flaccid weakness depending on the level of the lesion, and bilateral sensory loss.
This most commonly occurs as a result of compression by a herniated lumbosacral disc. Veraguth was the first author to describe the diagnosis and surgical treatment of a patient with a conuscauda syndrome. The symptoms and signs of cauda equina syndrome tend to be mostly lower motor neuron lmn in nature, while those of conus medullaris syndrome are a combination of lmn and upper motor neuron umn effects see table 1, below. Annually, cauda equina syndrome ces is believed to newly affect between 1 person per 33,000 100,000. Dec 17, 2019 spontaneous conus medullaris infarction is a rare disease. Cauda equina syndrome ces is classically characterized by compression of the lumbar, sacral and coccygeal nerve roots distal to the end of the medullary cone at the height of vertebrae l1 and l2. Cauda equina syndrome, on the other hand, is a type of spinal cord injury that involves injury to the bundle of nerves. Signs and symptoms include low back pain, pain that radiates down the leg, numbness around the anus, and loss of bowel or bladder control. Cauda equina and conus medullaris syndromes clinical presentation.
520 1537 72 1519 564 130 445 358 1265 1654 1569 1501 559 792 46 381 888 44 851 79 909 1432 99 979 1254 553 1207 912 1645 1018 522 289 1334 521 483 5 990 1480 382 514 642 824 1429 162