Cases for finals #5 – Examination

Speech normal

HMF – normal

Cranial nerves – normal

ULs – normal

  • LLs
  • tone – normal
  • power – severe weakness of KF; ADF; APF
  • reflexes – reduced KJs; absent AJs
  • sensation – saddle anaesthesia; PR exam – reduced anal tone

Oddly, for a “spinal cord” problem, the signs are all “peripheral” – flaccid weakness, lost reflexes, loose anal tone. This is because the lesion doesn’t knobble the spinal cord but rather the peripheral nerves, before they break free from the shackles of the spinal column and make it into your feet, buttock and rectum (delightful image that).

As such, you get peripheral signs from a central lesion – usually a prolapsed disc.

Image result for cauda equina syndrome

Management is surgical and urgent. Straight to a scanner please and call your friendly spinal person for advice.

Cauda Equina Compression MRI
Case courtesy of Assoc Prof Frank Gaillard, From the case rID: 13942

Don’t understand? Go to the spinal part of the neuro-anatomy lecture for more (about half way through).

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