When compression or injuries to these nerves occur, it is called conus medullaris syndrome. Conus medullaris is actually at the end part of the spinal cord located at the lower back. Outline of discussion introduction anatomical overview conus medullaris syndrome trauma as an etiology cauda equina syndrome questions. Cauda equina syndrome and conus medullaris syndrome are most common in young men, possibly due to this population group being more. We describe herein a middle agedman with a conus medullaris infarct. Spinal cord ischemiainfarct after cauda equina syndrome. Conus medullaris and cauda equina syndromes nervous.
The spinal cord is composed of long tracts of myelinated nerve fibres known as white matter arranged around the periphery of a symmetrical butterflyshaped cellular matrix of gray matter. Spontaneous conus medullaris infarction is a rare disease. Conus medullaris syndrome spinal decompression machines. The conus medullaris is the end of the spinal cord, which is located in the lower back. 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. Intramedullary spinal cord tumors account for 1% of all central nervous system tumors 1 and some infectious diseases in the cm were reported as case reports 2 10.
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. But cauda equina syndrome is a secondary condition which results from a disease or infection of the cauda equina spinal nerves. These symptoms include low back pain, sciatica unilateral or, usually, bilateral, saddle sensory. The segment above the conus is termed the epiconus, consisting of spinal cord segments l4s1. Conus medullaris surgery for lumbar spine pain spine. Cauda equina syndrome vs conus medullaris syndrome explained. Get a printable copy pdf file of the complete article 569k, or click on a page image below to browse page by page. Conus medullaris syndrome radiology reference article. Nov 24, 2016 cauda equina vs conus medullaris syndrome 1. Cauda equinaconus medullaris syndrome as an isolated. The spinal cord tapers and ends at the level between the first and second lumbar vertebrae in an average adult. The nerve that passes through the conus medullaris is the one that controls the legs, genitals, bowels and the bladder.
A brief tutorial cauda equina is latin for horses tail, and the term refers to a bundle of nerve fibers and nerve roots located at the base of the spine. Symptoms of conus medullaris compression include lower back pain, tingling, numbness, weakness, loss of sensation in the groin, legs or feet, inhibited motor functions in the lower body, impotence and loss of bladder control. He underwent an l1l2 laminectomy with intradural resection of two lesions that were adherent to the conus. Two patients developed acute low back pain with mild asymmetric paraparesis, loss of perianal sensation and sphincter. Nerves that pass through the conus medullaris control your legs, bladder, bowels and genitals, and problems can occur if these nerves become compressed. May 03, 2020 treatment for conus medullaris syndrome differs based on the underlying cause. Introduction conus medullaris and cauda equina syndromes are clinical entities diagnosis based on clinical. Conus medullaris syndrome following multiple intrathecal.
Both tibial and peroneal f waves were absent on day 4. Conus medullaris syndrome is a secondary form of spinal cord damage resulting from injuries. Conus medullaris syndrome definition, symptoms, causes. We describe two patients with spontaneous conus medullaris infarction presenting as acute cauda equina syndrome and their unique electromyography emg findings. Nerve roots travel from the spinal cord to the intervertebral foramina of the corresponding vertebrae, where they exit the spinal canal. The pathophysiology underlying neurologic decline includes venous hypertension, ischemia, hemorrhage, and mass effect from hugely dilated venous structures. Conus medullaris syndrome cms and cauda equina syndrome ces are complex neurological disorders that can be manifested through a variety of symptoms. Conus medullaris syndrome symptoms in rare cases of conus medullaris, paralysis occurs in half part of body. 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.
Full text full text is available as a scanned copy of the original print version. Following the diagnosis of conus medullaris infarction, the patient was admitted under the neurology service for management. 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. An overview of the pathologic processes of this region is provided. The conus medullaris is the bundled, tapered end of the spinal cord nerves. Many authors2,3,14,17,18,22,27,34,36,40,41 have defined variable treatment algorithms for the management of ces caused by acute herniation of the nucleus. Conus medullaris syndrome is caused by an injury or insult to the conus medullaris and lumbar nerve roots.
Epidemiological, clinical and neuroradiological characteristics of neoplastic glial tumors, nonglial tumors, metastasis, primary melanomas and nonneoplastic lesions. Astrocytomas are usually long and may extend from the lower brainstem to the conus medullaris. Conus medullaris syndrome cms and cauda equina syndrome ces are wellknown neurological entities. 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. Isolated neurological symptoms are estimated to be less than 30% in cns ivlbcl.
Intravascular large cell lymphoma ilcl is a diagnostic challenge, with neurological, cutaneous and constitutional symptoms. Injuries at the level of t12 to l2 vertebrae are most likely to result in conus medullaris syndrome. Pain in the neck may be associated, but bowel and bladder function are normal. Conus medullaris definition of conus medullaris by the.
Weakness of one arm is characteristic of one syndrome. Conus medullaris and cauda equina syndromes online. Conus medullaris syndrome manifest symptoms that are similar to cauda equina syndrome, but the two conditions require different treatment. Lesions of the epiconus will affect the lower lumbar roots supplying muscles of the lower part of the leg and foot, with. This condition can cause pain and neurological deficits i. Cauda equina and conus medullaris syndromes article pdf available in medscape journal of medicine march 20 with 7,435 reads how we measure reads. Pdf cauda equina and conus medullaris syndromes semantic. He underwent an l1l2 laminectomy with intradural resection.
Goldstein, md in vivo studies of the location of the normal conus medullaris in infancy and childhood have been extended to the fetus utilizing sonography. Consequently, problems with the conus medullaris often affect the cauda equina. Six months ago cms conus medullaris syndrome was diagnosed. The conus medullaris is the terminal end of the spinal cord gross anatomy. Absent f wave in the stage of spinal shock has been described in cases of traumatic spinal cord injury. Lumbar spine mri demonstrated conus enlargement and an intramedullary mass of predominant isointensity, heterogeneity with central necrosis. 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 arachnoid cyst presenting as cauda equina syndrome. Mar 06, 20 cauda equina and conus medullaris syndromes article pdf available in medscape journal of medicine march 20 with 7,435 reads how we measure reads. Conus medullaris surgery for lumbar spine pain spine surgery mn. Conus medullaris definition of conus medullaris by medical. Ependymoma is the most common spinal intramedullary neoplasm in adults. Two patients developed acute low back pain with mild asymmetric paraparesis, loss of perianal sensation and sphincter dysfunction.
Mri of conus medullaris, cauda equina, and filum terminale. A person with conus medullaris syndrome has symptoms that occur when the nerves in the conus medullaris malfunction. Conus medullaris and cauda equina syndrome as a result of. Patients can present with symptoms of isolated cauda equina syndrome, isolated conus medullaris syndrome, or a combination. It is a clinical subset of spinal cord injury syndromes. This could be accomplished through surgery, medication or even radiation therapy, depending on what the foreign body is. 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.
Intramedullary spinal lesions in the conus medullaris cm, including tumors, infection and vascular lesion, are rarely reported. Conus medullaris syndrome is a condition of the terminal end of the spinal cord, at the lower backbuttocks area from traumatic injury or from birth congenital. Conus medullaris medical definition merriamwebster. 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. After the cord terminates, the nerve roots descend within the spinal canal as individual rootlets, collectively termed the cauda equina. The conus medullaris, which is the terminal segment of the adult spinal cord, lies at the inferior aspect of the l1 vertebrae. Other than this patient complains about severe back pain, some strange sensations in back bone, dysfunctioning of bowel and bladder, patient faces difficulty while fecal discharge and abnormal sexual functioning. 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. Any malfunction that occurs in the conus medullaris results to what they call the conus medullaris syndrome. Cauda equina is a rare syndrome that can lead to paralysis if left untreated. This case of conus medullaris syndrome, which occurred coincident with multiple intrathecal steroid injections, suggests a more cautious approach to the treatment of benign disease by this method. 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. Apr 27, 2016 nerves that pass through the conus medullaris control your legs, bladder, bowels and genitals, and problems can occur if these nerves become compressed. Intramedullary and extramedullary intradural metastases, although.
If you experience any of these symptoms, speak to a spinal surgeon as soon as possible. Most spinal cord injuries involve the cervical or midthoracic spinal cord. Weakness in right lower limb along with thinning of limb x 1 year 3. 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. After the cord terminates, the nerve roots descend within the spinal canal as individual rootlets, collectively termed the cauda equina the conus medullaris most commonly terminates at the l12 intervertebral disc level in children and adults extending from the conus is a delicate.
It is distal to the tapered end of the spinal cord, or conus medularis. It is assumed that these syndromes are different regarding neurological and functional prognosis. Jun 14, 2018 patients can present with symptoms of isolated cauda equina syndrome, isolated conus medullaris syndrome, or a combination. Spontaneous conus medullaris infarction in a 79 yearold female with cardiovascular risk factors demonstrated by an adherent intraluminal filling defect thrombus within the aorta figures 4a and 4b. Comparatively, cauda equina syndrome may cause radicular pain, bowel. This prospective study of 33 fetuses showed that the. The conus medullaris extends further inferiorly than normal in a condition known as tethered cord syndrome. The most distal bulbous part of the spinal cord is. Cauda equina and conus medullaris syndromes clinical. 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. Conus medullaris definition of conus medullaris by. Jul 19, 2019 definition of conus medullaris and cauda equina syndromes. If the area is compressed by a tumor or hematoma, removing the object causing the compression will ease the symptoms.
However, literature concerning spinal trauma is ambiguous about the exact definition of the syndromes. Disorders of the lumbosacral junction and cauda equina. The cauda equina latin for horses tail begins at the 2nd lumbar space extending down to the beginning of the sacral nerves. Cauda equina and conus medullaris syndromes statpearls. Intrathecal metastases causing conus medullaris syndrome. In the dog the spinal cord conus medullaris ends at around l6l7. Conus medullaris syndrome is a collection of signs and symptoms associated with injury to the conus medullaris. But cauda equina syndrome is a secondary condition which results from a disease or infection of the cauda equina spinal nerves the cauda equina. 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. Spinal cord compression nontraumatic cauda equina syndrome. Conus medullaris and cauda equina syndromes online medical.
Some symptoms are similar to ces but not identical. Conus medullaris syndrome is less severe than above, but they tend to have back pain with a minimal radicular component. The role of f wave in predicting prognosis after conus medullaris infarct has not been described. Conus medullaris synonyms, conus medullaris pronunciation, conus medullaris translation, english dictionary definition of conus medullaris. Conus medullaris definition,syndrome,symptoms and more. The conus medullaris most commonly terminates at the l12 intervertebral disc level in children and adults. Clinical, neuroimaging, and nerve conduction characteristics. Pdf conus medullaris arachnoid cyst presenting as cauda. The conus medullaris is the terminal end of the spinal cord. Definitions of traumatic conus medullaris and cauda equina.
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. Other articles where conus medullaris is discussed. Sep 27, 2008 the medullary conus represents a distinct entity of the spinal cord regarding its anatomical, clinical and microsurgical features. The normal location of the fetal conus medullaris michelle l. Most cases of paralysis are due to catastrophic injuries, such as sustained blows to the head or neck, car accidents, or athletic injuries. Neurenteric cyst of the conus medullaris surgical neurology. Compression is the main reason someone would suffer. Conus medullaris definition of conus medullaris by the free. Often very prominent and severe, asymmetrical, radicular motor findings. To diagnose you with conus medullaris syndrome, your doctor may conduct mri imaging of your lower back and spine.
Conus medullaris syndrome inspired spinal cord injury. Although neurologically intact, the mri documented an l1conus medullaris intradural, nonenhancing, thinwalled, cystic lesion resulting in significant cauda equina compression. The initial features of multiplesegment spinal astrocytomas may occur in the arms or legs. An unusual cause of conus medullaris syndrome neurology. The medullary conus represents a distinct entity of the spinal cord regarding its anatomical, clinical and microsurgical features. Spontaneous conus medullaris infarction in a 79 yearold. The gray matter contains cell bodies, unmyelinated motor neuron. Cauda equina syndrome vs conus medullaris syndrome explained dr. Oct 16, 2017 cauda equina syndrome vs conus medullaris syndrome explained dr.
Spinal cord infarction is rare and occurs in 12100,000. 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. Strange or jarring sensations in the back, such as buzzing, tingling, or numbness. Epidemiological, clinical and neuroradiological characteristics of neoplastic glial tumors, nonglial tumors, metastasis, primary melanomas and nonneoplastic lesions granulomatous lesions. However, about a third of spinal cord injuries affect the lower thoracic spinal segments where. It refers to a collection of symptoms that arise due to damage to the conus medullaris. Definitions of traumatic conus medullaris and cauda equina syndrome. Conus medullaris syndrome is a type of incomplete spinal cord injury that is less likely to cause paralysis than many other types of spinal cord injuries. Pdf the spinal cord tapers and ends at the level between the first and second lumbar vertebrae in an average adult. This has frequently led to many unusual complications.
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