Now, let's visit another important
topic called cauda equina.
As the name implies,
looks like the horse's tail.
Remember, normal spinal cord
tapers just at the lumbar region.
Compression of the lumbar sacral nerve's roots
below the level of the conus medullaris
causes cauda equina.
Do you know what symptoms
are included in the cauda equina?
I’ll give you a second to think about this.
Cauda equina classically is
associated with saddle numbness.
That’s highlighted here by
the green on our manikin.
You can see variable areflexic
paraplegic or atrophy in the extremities.
Sometimes patients have urinary retention.
And some patients have severe neuropathic pain.
But what's the difference between
conus medullaris versus cauda equina?
Here’s an important table for its differentiation.
Let's go over each section.
In conus medullaris,
the level of injury is actually at
the termination of the spinal cord.
This is actually before the tail fiber split.
There is usually impotence.
Motor exam involves symmetric,
hyperreflexia, less marked weakness.
Remember, hyperreflexia is a sign
of upper motor neuron disease.
Sensory loss is usually around the perianal region
and it can have rapid symptoms.
Generally, patients also complain
of bowel and bladder incontinence.
Let's compare this to cauda equina.
Cauda equina involves again the tracts
leading to the peripheral nerve systems.
There is variable presentation of impotence.
The motor exam, however, is asymmetric
depending on the side of the
injury or the side that's involved.
Unlike, the hyperreflexia in conus medullaris,
we see areflexia and profound weakness.
And as a reminder,
the sensory exam shows the saddle
distribution on the previous slide.
Generally speaking, the acuity is slower onset.
It's important for you to be able to differentiate
where the level of the injury is between
conus medullaris and cauda equina.
Now, it's time to visit some important clinical pearls
and high-yield information.
Under spinal cord syndromes,
it's very important to understand
the normal sensory and motor tracts
to help you determine where
the actual neurological deficits are.
Go back to those previous slides
and review where all the normal tracts run
and their associated sensory or motor deficits.
Then you can figure out the syndromes
when presented on a clinical scenario.
And remember, cauda equina syndrome
is potentially a neurosurgical emergency.
Don’t sit on these patients for too long.
Thank you very much for joining me
on this discussion of neurological spinal cord syndromes.