Conus Medullaris Syndrome MOIN UD DIN MBBS, MD SKZMDC Acute back - - PowerPoint PPT Presentation

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Conus Medullaris Syndrome MOIN UD DIN MBBS, MD SKZMDC Acute back - - PowerPoint PPT Presentation

Aug 03, 2023 449 likes •537 views

Conus Medullaris Syndrome MOIN UD DIN MBBS, MD SKZMDC Acute back pain radiating to 1. bilateral lower limbs Urinary retention 2. Stool retention 3. Presentation Perianal Numbness 4. Numbness and tingling sensation 5. in bilateral

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SLIDE 1

Conus Medullaris Syndrome

MOIN UD DIN MBBS, MD SKZMDC

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SLIDE 2

Presentation

1.

Acute back pain radiating to bilateral lower limbs

2.

Urinary retention

3.

Stool retention

4.

Perianal Numbness

5.

Numbness and tingling sensation in bilateral lower limbs

6.

Sexual Dysfunction (Impotence in men)

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SLIDE 3

Signs

Both upper and lower motor neuron signs present Babinski reflex and Bulbocavernosus reflex present Hyperreflexia and flaccidity are concurrently presently Achilles reflex is affected; Patellar reflex is preserved

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Pathophysiology and Risk factors

 Conus medullaris is the end part of spinal cord.  In most adults it is as L-2 levels with some variations from T-12 to L-2

levels.

 Compression of spinal cord at this level is conus medullaris

syndrome.

 Most common cause is trauma.  Other causes include Infections (Tb, HSV, Meningitis, CMV) and

malignancy(Primary and metastasis).

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SLIDE 5

Diagnosis

 Thorough history is important to look for recent

trauma or chiropractic manipulation, history of malignancy, intravenous drug use and constitutional symptoms like fever/chills.

 Detailed physical examination is important to

differentiate from other spinal compression causes.

 Look for presence of UMN and LMN signs,

Palpable bladder showing urinary retention, Absent or decreased rectal tone/ Bulbocavernosus reflex.

 Gold standard for diagnosis is Urgent MRI

Ideally within 1 hour of presentation for favorable prognosis.

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SLIDE 6

Differential Diagnosis

 Cauda Equina Syndrome  Spinal Cord Infarct  Multiple Sclerosis  Infections

i.

HIV-related Myelopathy

ii.

Transverse Myelitis

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SLIDE 7

Management

 Surgical Decompression (Laminectomy) is the main treatment

  • ption

 If cause is cancer, radiation therapy ( Brachytherapy ) maybe

required

 Physical therapy is essential to regain function.

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SLIDE 8

Prognosis

Prognosis is favorable with early recognition and treatment. Ideally treatment within 48 hours of presentation is much better.