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Wednesday, January 07, 2009

Which of the following is not a feature of Conus Syndrome

Question 79
Which of the following is not a feature of Conus Syndrome
a.       Late Bladder involvement
b.      Saddle Anaesthesia
c.       Bilateral signs
d.      Affects sacral segments
Answer
a. Late Bladder involvement
Reference
Textbook of Medicine : Vasan and Seshadhri 1st Edition Pages 463-465
QTDF
Textbook of Medicine :
Quality
Thinker
Status
Repeat
Discussion
Conus medullaris syndrome (CMS) and cauda equina syndrome (CES) are complex neurological disorders that can be manifested through a variety of symptoms. Patients may present with back pain, unilateral or bilateral leg pain, paresthesias and weakness, perineum or saddle anesthesia, and rectal and/or urinary incontinence or dysfunction. Although patients typically present with acute disc herniations, traumatic injuries at the thoracolumbar junction at the terminal portion of the spinal cord and cauda equina are also common.
Explanation
Self Explanatory
Comments
Since this is a memory recollected paper, there was as considerable discussion regarding the choices. Few students were of the opinion that “Muscle Spasticity” “Involvement of Knee and Ankle Jerks” were also in the choices
Tips
Conus Medullaris Syndrome
Cauda Equina Syndrome
More likely to present with bilateral signs since the conus is compact
More likely to be unilateral at onset
Isolated conus lesions cause no lower limb weakness; if concomitant nerver root involvement occurs, L3 which lies close to the tip of the conus is most often affected – weak quadriceps L3 hyperalgesia
Typically, there is unilateral lower limb weakness involving feet and toes
Saddle anaesthesia seen early without weakness or anaesthesia elsewhere
Saddle anaesthesia seen late with bilateral lower limb weakness, sensory findings
Absent Anal reflex, bladder involvement Early
Rare, Late
Aching low back pain
Root pain radiating into legs

58 comments:

  1. //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

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