Showing posts with label Epiconus. Show all posts
Showing posts with label Epiconus. Show all posts

Tuesday, March 23, 2010

Epiconus, Conus and Cauda Equina syndromes


Epiconus Syndrome:

The epiconus syndrome presents with the following clinical features.

A sensory disturbance in the leg (transverse, saddle, radicular, or socks type).

Motor deficit as a sign of lower motor neuron involvement (foot drop, fasciculation, muscle atrophy).

Diminished deep tendon reflexes.

Occasional coexistence of positive pathological reflexes (Babinski's and Chaddock's signs).

Diminished vibration sensation, and

Bladder and bowel dysfunction.

Conus Medullaris Syndrome:

Mixed LMN and UMN type of picture seen

During the Acute phase paralysis of lower extremities with flaccid rectal tone and urinary retention are found.

In chronic phase there is evidence of atrophy and hyperreflexia.

The defecits tend to be symmetrical.

The prognosis for bowel and bladder function is relatively poor.

In pure Conus medullaris syndrome as in Intramedullary lesions there is total absence of motor disturbances inlower limbs and absent Babinski and other pathological pyramidal tract signs

CaudaEquina Syndrome:

Early radicular type of pain, Late sphincter disturbances,  and Asymmetrical sensory findings are characteristics.

Pain is unilateral or asymmetrical 

Develops flaccid, Hypotonic, areflexic paralysis true peripheral type of paraplegia.

Asymmetric sensory loss in saddle region involving anal, perineal and genital regions.

Ankle jerk is absent and has variable Knee jerk


Epiconus, Conus, Periconus and Cauda Equina

Anatomically, the epiconus comprises the cord segment between L4 and S1, corresponding to the T12 and L1 vertebrae.*

The conus medullaris consists of the cord segment between S2 and S5 as well as coccygeal segments.**

Anatomically periconus includes the Epiconus and Conus Medullaris

The cauda equina is a structure within the lower end of the spinal column that consists of nerve roots and rootlets from spinal segments L3 to Coccygeal nerve. At the base of the Cauda Equina, there are approximately 10 root pairs, 3-5 lumbar, 5 sacral, and the single coccygeal nerve.

*= Bullough P G, Boachie-Adjei O. Development of the Spinal Cord. 

 In: Atlas of the Spinal Diseases. JB Lippincott: Philadelphia, 1988,pp53.

** =  Di Pietro M A. The conusmedullaris : normal US findings throughout childhood.

Radiology 1993; 188: 149 - 153.