Cauda Equina and Conus Medullaris

00:01 Now, let's visit another important topic called cauda equina.

00:06 As the name implies, looks like the horse's tail.

00:09 Remember, normal spinal cord tapers just at the lumbar region.

00:13 Compression of the lumbar sacral nerve's roots below the level of the conus medullaris causes cauda equina.

00:21 Do you know what symptoms are included in the cauda equina? I’ll give you a second to think about this.

00:29 Cauda equina classically is associated with saddle numbness.

00:33 That’s highlighted here by the green on our manikin.

00:38 You can see variable areflexic paraplegic or atrophy in the extremities.

00:45 Sometimes patients have urinary retention.

00:48 And some patients have severe neuropathic pain.

00:54 But what's the difference between conus medullaris versus cauda equina? Here’s an important table for its differentiation.

01:02 Let's go over each section.

01:04 In conus medullaris, the level of injury is actually at the termination of the spinal cord.

01:10 This is actually before the tail fiber split.

01:14 There is usually impotence.

01:17 Motor exam involves symmetric, hyperreflexia, less marked weakness.

01:23 Remember, hyperreflexia is a sign of upper motor neuron disease.

01:27 Sensory loss is usually around the perianal region and it can have rapid symptoms.

01:34 Generally, patients also complain of bowel and bladder incontinence.

01:38 Let's compare this to cauda equina.

01:41 Cauda equina involves again the tracts leading to the peripheral nerve systems.

01:46 There is variable presentation of impotence.

01:50 The motor exam, however, is asymmetric depending on the side of the injury or the side that's involved.

01:56 Unlike, the hyperreflexia in conus medullaris, we see areflexia and profound weakness.

02:04 And as a reminder, the sensory exam shows the saddle distribution on the previous slide.

02:09 Generally speaking, the acuity is slower onset.

02:12 It's important for you to be able to differentiate where the level of the injury is between conus medullaris and cauda equina.

02:20 Now, it's time to visit some important clinical pearls and high-yield information.

02:24 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.

02:33 Go back to those previous slides and review where all the normal tracts run and their associated sensory or motor deficits.

02:41 Then you can figure out the syndromes when presented on a clinical scenario.

02:48 And remember, cauda equina syndrome is potentially a neurosurgical emergency.

02:52 Don’t sit on these patients for too long.

02:56 Thank you very much for joining me on this discussion of neurological spinal cord syndromes.