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Wednesday, January 07, 2009

Which is not a feature of Extramedullary Tumour Sacral Sparing

Question 78
Which is not a feature of Extramedullary Tumour
a.       Early Corticospinal Signs and Descending paralysis
b.      Root pain or Midline Back Pain
c.       CSF Abnormal
d.      Sacral sparing
d. Sacral Sparing
Textbook of Medicine : Vasan and Seshadhri 1st Edition Pages 463-465
Textbook of Medicine :
Extramedullary Lesion
Intramedullary Lesion
Root pain or Midline Back Pain
Funicular Pain
Brown Sequard Syndrome
Dissociated anaesthesia
Early Corticospinal Signs
Corticospinal signs late and less prominent
Early loss of sacral sensation
Sacral sparing
CSF Abnormal
CSF more likely to be normal
Self Explanatory
Classically in a extramedullary lesion, the ipsilateral lower limb is involved first followed by the ipsilateral upper limb and then contralateral upper limb and contralateral lower limb. Be careful when you see the words Ascending paralysis or Descending Paralysis in future exams
The Author of the book (I have given for reference) is from AIIMS J


  1. Conus medullaris syn. being an intra medullary lesion- in this page the discussion says there is 'sacral sparing' in IM lesion & for the next question the disucssion says 'absent anal reflex' for conus syn. are they both not contradictory?

  2. //are they both not contradictory?//

    Yes... !!!

    # Signs of cauda equina syndrome include the following:

    * Muscle strength in the lower extremities is diminished. This may be specific to the involved nerve roots as listed below, with the lower lumbar and sacral roots more affected, leading to diminished strength in the glutei muscles, hamstring muscles (ie, semimembranosus, semitendinosus, biceps femoris), and the gastrocnemius and soleus muscles.
    * Sensation is decreased to pinprick and light touch in a dermatomal pattern corresponding to the affected nerve roots. This includes saddle anesthesia (sometimes including the glans penis or clitoris) and decreased sensation in the lower extremities in the distribution of lumbar and sacral nerves. Vibration sense may also be affected. Sensation of the glans penis or clitoris should be examined.
    * Muscle stretch reflexes may be absent or diminished in the corresponding nerve roots. Babinski reflex is diminished or absent.
    * Bulbocavernosus reflexes may be absent or diminished. This should always be tested.
    * Anal sphincter tone is patulous and should always be tested since it can define the completeness of the injury (with bulbocavernosus reflex); it is also useful in monitoring recovery from the injury.
    * Urinary incontinence could also occur secondary to loss of urinary sphincter tone; this may also present initially as urinary retention secondary to a flaccid bladder.

    * Muscle tone in the lower extremities is decreased, which is consistent with an LMN lesion.

    # Signs of conus medullaris syndrome include the following:

    * Patients may exhibit hypertonicity, especially if the lesion is isolated and primarily UMN.
    * Signs are almost identical to those of the cauda equina syndrome, except that in conus medullaris syndrome signs are more likely to be bilateral; sacral segments occasionally show preserved bulbocavernosus reflexes and normal or increased anal sphincter tone; the muscle stretch reflex may be hyperreflexic, especially if the conus medullaris syndrome (ie, UMN lesion) is isolated; Babinski reflex may affect the extensors; and muscle tone might be increased (ie, spasticity).
    * Other signs include papilledema (rare, occurs in lower spinal cord tumors), cutaneous abnormalities (eg, cutaneous angioma, pilonidal sinus that may be present in dermoid or epidermoid tumors), distended bladder due to areflexia, and other spinal abnormalities (noted on lower back examination) predisposing the patient to the syndrome.


    We will refer and Correct it as per the standard Books

  3. True!! i too read this 'sacral segments occasionally show preserved bulbocavernosus reflexes and normal or increased anal sphincter tone'- which means sacral sparing is occasional. That is why i wrote to you.. thanks for your instant reply