Symptoms of conus lesion and cauda equina syndrome

1. Big picture

Conus medullaris syndrome and cauda equina syndrome are emergency localization topics. Both can present with lower back pain, leg weakness, sensory disturbance, urinary retention, fecal dysfunction, and sexual dysfunction. The exam task is to separate them from simple radiculopathy and from spinal cord myelopathy.

The most important message:

In a patient with low back pain or sciatica, urinary retention, saddle anesthesia, reduced anal tone, or bowel/sexual dysfunction means conus or cauda involvement until proven otherwise.

These syndromes are dangerous because delayed diagnosis may leave permanent bladder, bowel, sexual, sensory, and motor deficits.