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. The cauda equina play a key role in lower body movement and sensation, including walking, elimination, bladder function, sexual function, and most other movements of the legs and lower body. Pdf conus medullaris syndrome due to spinal cord iscemia. Methods in a 47yearold man, paraplegia of the lower extremities developed, specifically conus medullaris syndrome, after he underwent an esi for recurrent pain. Conus medullaris and cauda equina syndrome pdf download, rs aggarwal quantitative aptitude pdf free download 2014 pdf 1cc1596b1f share on facebook share on twitter. Cauda equinaconus medullaris syndrome as an isolated. Ependymoma is the most common spinal intramedullary neoplasm in adults. Therefore, for the purpose of this discussion, they will be grouped, and notable differences highlighted. Consequently, problems with the conus medullaris often affect the cauda equina.
The condition usually develops when the nerves in the conus medullaris find it unable to function correctly as a result of constriction of the lower part of the spinal column or undue pressure. Most spinal cord injuries involve the cervical or midthoracic spinal cord. Background the prognosis for cauda equina syndrome ces improves if a definitive cause is identified and management is instituted early. It is assumed that these syndromes are different regarding neurological and functional prognosis. A conus injury is a similar injury but is higher up in the cord around l1 or l2 level at the level of the conus of the cord. We describe two patients with spontaneous conus medullaris infarction presenting as acute cauda equina syndrome and their unique electromyography emg findings.
It refers to a collection of symptoms that arise due to damage to the conus medullaris. The conus medullaris is the terminal end of the spinal cord, which typically occurs at the l1 vertebral level in the average adult. Rawlings, md, jd, rawlings neurosurgical consultingthe mackenzie law firm, winstonsalem, nc editors note. Cauda equina syndrome refers to a characteristic pattern of neuromuscular. Cauda equina syndrome, on the other hand, is a type of. Immediately after the injection, the patient felt his legs going dead. Conus medullaris syndrome following multiple intrathecal. Conus medullaris andcauda equina syndromes temple university hospital. Ortho conus medullaris and cauda equina syndrome free download as powerpoint presentation. Conus medullaris syndrome pdf analysis of stress application at the thoracolumbar junction. Conus medullaris syndrome due to missed thoracolumbar spinal.
In the lumbar region of the spine, there is a spray of spinal nerve roots called the cauda equina. Cauda equina syndrome an overview sciencedirect topics. Kesler at el5 reported that the conus virtually never ends below the mid l2 level. Few serious complications have been associated with the intrathecal administration of corticosteroids in the treatment of lumbar radiculopathy. Subtle imaging findings in a case of tight filum terminale. Ortho conus medullaris and cauda equina syndrome nervous. Conus medullaris definition,syndrome,symptoms and more. It can present as varying degrees of pain or neurologic deficit limited to the lower extremities, and it can create. Therefore, this case report explored the possibility of dynamic mri with the hips in neutral. The conus medullaris latin for medullary cone or conus terminalis is the tapered, lower end. Although extremely rare, pure conus medullaris syndrome may occur with l1 burst fracture. Situated near the first two lumbar vertebrae, the conus medullaris ends at the cauda equina, a bundle of spinal nerves and nerve roots. The following can be used as guidelines to predict and assist the therapist and patients in.
Two patients developed acute low back pain with mild asymmetric paraparesis, loss of perianal sensation and sphincter dysfunction. Pdf conus medullaris syndrome is a clinical condition characterized by symmetrical weakness in the legs, sensory loss and urinary and fecal. All nerves associated with the cauda equina originate in the spinal cords conus medullaris. Conus medullaris syndrome is a secondary form of spinal cord damage resulting from injuries to the lumber vertebrae. Intrathecal metastases causing conus medullaris syndrome. Lumbar spine magnetic resonance imaging mri demonstrated a 2 cm enhancing mass in the conus medullaris figure 1, arrow occluding the entire spinal canal and a 0. Clinical, neuroimaging, and nerve conduction characteristics of.
Spinal cord stimulation at the conus medullaris for. Spinal cord infarction is rare and occurs in 12100,000. Other congenital malformations of posterior segment of eye. Cauda equina syndrome ces is a clinical representation of local anesthetic neurotoxicity. Conus medullaris syndrome is a collection of signs and symptoms associated with injury. Pdf conus medullaris arachnoid cyst presenting as cauda. Injury to the conus medullaris commonly results in sudden nonspecific low back pain that progresses to bilateral leg pain with bladder and bowel dysfunction and saddle anesthesia. In fact, the same patients may visit the ed repetitively with the same complaint. Conus medullaris syndrome due to missed thoracolumbar spinal fracture in a patient with ankylosing spondylitis who. Spontaneous conus medullaris infarction in a 79 yearold.
Surgical treatment may be necessary for decompression or tumor removal, especially if the patient presents with acute onset of symptoms. Annually, cauda equina syndrome ces is believed to newly affect between 1 person per 33,000 100,000. Case 41996 a 40yearold woman with the rapid onset of flaccid. The following is the supplementary data to this article. Developed for nice by the national collaborating centre for cancer. The anatomical variation in conus medullaris termination and the theoretical possibility of occult tethered cord syndrome make it difficult to consider an abnormal caudal position of the conus medullaris as a reliable diagnostic criterion in dogs. 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. 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. Aqp antikor mogensefalomyelit ms ms kriterlerini kar.
Surgical outcomes in thoracolumbar fractures with pure conus. Cauda equina syndrome and conus medullaris syndrome result from. Low back pain is a frequent patient complaint in the emergency department ed. This case of conus medullaris syndrome, which occurred coincident with multiple intrathecal steroid injections. Correct needle placement was verified with epidurography. Spontaneous conus medullaris infarction is a rare disease. The spinal cord tapers and ends at the level between the first and second lumbar vertebrae in an average adult. Injuries at the level of t12 to l2 vertebrae are most likely to result in conus me. What links here related changes upload file special pages permanent link. The distal tapered tip of the spinal cord is the conus medullaris cm. Timing is key for cauda equina syndrome diagnosis in the ed. Frontiers dynamic lumbosacral magnetic resonance imaging. Conus medullaris and cauda equina syndrome pdf download. Conus medullaris and cauda equina syndrome as a result of.
Conus medullaris syndrome after epidural steroid injection. However, literature concerning spinal trauma is ambiguous about the exact definition of the syndromes. Conus medullaris and cauda equina syndromes slideshare. Less prominent sources of blood supply include radicular. The incidence of pure conus medullaris syndrome in thoracolumbar burst fractures is extremely rare. The dura is seen as two lchogtnic lapering lines arraws. Servikaltorakal konus medullaris kordda persistan t2 sinyal kordda atrofi. At the request of several members, i am writing a summary of conus medullaris injuries, its clinical manifestations and what potential therapies are being developed to restore function in such injuries. Definition of conus medullaris and cauda equina syndromes 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. Conus medullaris syndrome is a collection of signs and symptoms associated with injury to the conus medullaris. Outline of discussion introduction anatomical overview conus medullaris syndrome trauma as an etiology cauda equina syndrome questions 3. Conus medullaris syndrome cms and cauda equina syndrome ces are complex neurological disorders that can be manifested through a variety of symptoms. Regardless of the epidemiology, ces is a spinal emergency necessitating quick and effective care to mitigate permanent neurological sequelae.
Timing is key for cauda equina syndrome diagnosis in the. Conus medullaris syndrome cms and cauda equina syndrome ces are wellknown neurological entities. The most distal bulbous part of the spinal cord is called the conus medullaris, and. Cauda equina and conus medullaris syndromes statpearls. Definitions of traumatic conus medullaris and cauda equina. Conus medullaris syndrome involves injury of the sacral cord conus and lumbar nerve roots within the neural canal, which usually results in an areflexic bladder, bowel, and les. An approach to the diagnosis of acute transverse myelitis. Spinal cord stimulation at the conus medullaris for treatment refractory pudendal. Conus medullaris syndrome radiology reference article. Spinal cord at the conus medullaris for treatment refractory pudendal. Mri of conus medullaris, cauda equina, and filum terminale.
The conus medullaris is the bundled, tapered end of the spinal cord nerves. 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. Cauda equina syndrome transient neurologic syndrome. Conus medullaris andcauda equina syndromes temple university hospital november 22, 2006 presented by darric e. Conus medullaris syndrome symptoms back pain unilateral or bilateral leg. Conus medullaris syndrome is less severe than above, but they tend to have back pain with a minimal radicular component. Spinal cord ischemiainfarct after cauda equina syndrome.
The conus medullaris obtains its blood supply primarily from 3 spinal arterial vessels. Conus medullaris syndrome is caused by an injury or insult to the conus medullaris and lumbar nerve roots. We report a 25yearold man who had an intradural arachnoid cyst at the level of conus medullaris presenting with cauda equina syndrome, which is very rare. It is a clinical subset of spinal cord injury syndromes. Conus medullaris and cauda equina syndromes nervous. Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Diagnosis and management of patients at risk of or with metastatic spinal cord compression. Anatomy of the spine 7 cervical vertebrae 12 thoracic vertebrae 5 lumbar vertebrae 5 fused sacral vertebrae 34 small bones comprising the coccyx. However, about a third of spinal cord injuries affect the lower thoracic spinal segments where the lumbosacral spinal. Spontaneous conus medullaris infarction can occur in healthy individuals and presents as cauda equina syndrome. The spinal cord with its normal central echo, the conus medullaris and the dural sac were visual ized fig. Conus medullaris and cauda equina syndromes free download as powerpoint presentation.