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.