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  #1  
Old 09-21-2012
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Anatomy Loss of pain and touch sensation + incontinence!

A 44 yr old male has been taken to a physician by his wife complaining about his recent illness. his complaints include passing of urine unknowingly in some public places which makes him annoy mostly. he also states sometimes he unable to feel the touch and pain sensation of his knees and toes, additionally with fecal incontinence since 1 month. on further evaluation no upperlimb changes are seen..his lab tests are normal without any abnormalities. no multiple sexual partners exist..he also states from this 1 month he is unable to participate in any sexual activities...what is the underlying cause of it..?

a) syringomyelia
b) ALS
c) conus medullaris syndrome
d) anterior spinal artery occlusion
e) cauda euina syndrome
f) poliomyelitis
g) epiconus syndrome
h) tabes dorsalis
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  #2  
Old 09-22-2012
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My answer is E) Cauda equina syndrome. The patient has urinary and fecal incontinence as well as sexual impairment and loss of sensation over his knees and toes which demonstrate compression of the lumbar roots below conus terminalis of the spinal cord.
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Old 09-22-2012
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Default My asnwer E

I was stuck between D and E, cause both present incontinence
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Old 09-22-2012
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Considering his symptoms
I would go with cauda equine syndrome


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Old 09-22-2012
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E.cauda equina syndrome: h/o fecal + urinary incontinence + loss of pain/touch sensation over lower extremities..
patient can walk
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Old 09-24-2012
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Post G is right

the most appropriate answer is G) epiclonus syndrome

in the stem.., pt. has pain ,touch sensation loss(sensory) and fecal incontinence,sphincter problems,impotence(motor and sensory)

so, ALS( only motor), poliomyelitis(only LMN)...are excluded

ant. spinal artery occlusion and syringomyelia usually presents with concomitant upper limb defects------so excluded

as no sexually transmitted existence is stated---tabes dorsalis can also be excluded...

this leaves us to 3 options.....

in descending order according to origin

epiconus syndrome-------urethral sphincter problems, saddle anesthesia, fecal incontinence, impotence+ lower limb abnormalities.


conus medullaris syndrome------urethral sphincter problems, saddle anesthesia, fecal incontinence, impotence with no lower limb involvement

cauda equina syndrome------motor and sensory weakness in lowerlimbs and fecal incontinence without urethral sphinter problems and impotence(rarely seen)
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Old 09-24-2012
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Default @venky2600

pls where did you get this epiclonus syndrome?
i checked wiki and googled it but theres no name like that
and cauda equina syndrome and conus medullaris syndrome has same presentation and they pointed out doctors should not try to differentiate between the 2 since pathology,signs & symptoms with management are the same.

this is presentation of cauda equina syndrome;
Signs include weakness of the muscles of the lower extremeties innervated by the compressed lumbar roots (often paraplegia), detrusor weaknesses causing urinary retention and post-void residual incontinence as assessed by catheterizing after the patient has urinated. Also, there may be decreased anal tone and consequent fecal incontinence; sexual dysfunction; saddle anesthesia; bilateral leg pain and weakness; and bilateral absence of ankle reflexes. Pain may, however, be wholly absent; the patient may complain only of lack of bladder control and of saddle-anaesthesia, and may walk into the consulting-room.
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Old 09-24-2012
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Quote:
Originally Posted by chux View Post
pls where did you get this epiclonus syndrome?
i checked wiki and googled it but theres no name like that
and cauda equina syndrome and conus medullaris syndrome has same presentation and they pointed out doctors should not try to differentiate between the 2 since pathology,signs & symptoms with management are the same.

this is presentation of cauda equina syndrome;
Signs include weakness of the muscles of the lower extremeties innervated by the compressed lumbar roots (often paraplegia), detrusor weaknesses causing urinary retention and post-void residual incontinence as assessed by catheterizing after the patient has urinated. Also, there may be decreased anal tone and consequent fecal incontinence; sexual dysfunction; saddle anesthesia; bilateral leg pain and weakness; and bilateral absence of ankle reflexes. Pain may, however, be wholly absent; the patient may complain only of lack of bladder control and of saddle-anaesthesia, and may walk into the consulting-room.
ya....there are very minor changes in each of these 3 diseases...their presentation seems similar...i found these in dr. najeeb neuro anat videos(so thought like sharing with you guys...)...but he didnt say there is any alternate name for epiconus syndrome(it usually implies to any lesion above conus medullaris....)..............he also specified these 3 diseases in similar way i posted....anyways i may be wrong though(wiki may not be wrong)......
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Old 09-24-2012
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Didn't knew about this before, informative.
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Old 09-24-2012
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Quote:
Originally Posted by chux View Post
pls where did you get this epiclonus syndrome?
i checked wiki and googled it but theres no name like that
and cauda equina syndrome and conus medullaris syndrome has same presentation and they pointed out doctors should not try to differentiate between the 2 since pathology,signs & symptoms with management are the same.

this is presentation of cauda equina syndrome;
Signs include weakness of the muscles of the lower extremeties innervated by the compressed lumbar roots (often paraplegia), detrusor weaknesses causing urinary retention and post-void residual incontinence as assessed by catheterizing after the patient has urinated. Also, there may be decreased anal tone and consequent fecal incontinence; sexual dysfunction; saddle anesthesia; bilateral leg pain and weakness; and bilateral absence of ankle reflexes. Pain may, however, be wholly absent; the patient may complain only of lack of bladder control and of saddle-anaesthesia, and may walk into the consulting-room.
this might be helpful

conus medullaris syndrome presents with UMN and LMN (no sensory) in LL
epiconus---sensory and motor changes are seen...(spastic bladder--voluntary control lost)
cauda equina----late urethral sphincter problems(anyways it's flaccid baldder)

http://drsharathkumar.blogspot.in/20...da-equina.html
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Old 09-26-2012
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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
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  #12  
Old 11-26-2012
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short remembrance-epi as sen n motor ,conus as motor,cauda as sens
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Old 11-07-2013
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so suppose if in this ques the patient only had bladder issues and the lower limb prob and not the sexual issues it could have been syringomyelia right?

goljan audio mentions this :/
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