Cauda Equina Syndrome vs Conus Medullaris Syndrome EXPLAINED

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[@user-mk8bl1uc8x]

AWESOME VIDEO! It cleared concepts I didn't know I was lacking! Thank you so much for making this video.

[@gissellamartinez3005]

I can finally understand the topic. I was very confused about the differences, but you explained it in a wonderful way. Thank u!

[@tinahendricks917]

i have come back to this video again and again it is the best explanation of this differentiation i have ever seen

[@dinithiwanigasekara7102]

Really awesome video! This area was never clear to me before and you have explained it in such a simple way!

[@sijalrupakheti9399]

Very detailed and clear. I will never forget this now. Thank you!

[@SamSampeMana]

you're doing a great job sir! much gratitude, thank you!

[@leticiacampoverde4420]

Thank you so much for sharing your wonderful work. I nerver understood this topic until now :)

[@amitsinha4814]

Superb , marvellous ...as a surgery resident ...i m thankful to you for clearing all my concepts .. !!

[@kentchong8650]

Well explained! Thanks for the effort!

[@manalshahid1148]

Wow after yrs of medical education finally I got the concept of these topics👍🏻

[@AK-ez7hk]

Thanks for making this so much easy to understand.🔥

[@TimdubW]

sick video mate, helped me so much!

[@robertopalazzolo9140]

Awesome, thank you so much for explaining that. In lots of books or also internet, like Wikipedia etc, I didn't find all the differentiation of these two syndromes. But thanks to this video now I have a clear idea of how to differentiate these

[@introvertedbookkeeper9447]

thank you so much for this!!

[@lurodriguez1]

A+ on this video! Thank you for the explanation

[@lisa5483]

This is great! Thank you!

[@dawoodsohail5049]

so good man!!! ive had so much trouble with this topic till now.. you've explained it brilliantly! bravo

[@meghanas7779]

Very well put, thank you😊

[@sashagenis]

Thank you very much for this amazing explanation!!! :)

[@DrPilot23]

this is a PAID quality lecture. well done!!

[@shilpa1553]

nice effort! A brief yet explainatory video...

[@sunandkumarn.n1444]

Thank you for the video...clearly understood

[@drmeenakshiponmudi4596]

Wonderful explanation

[@chrisdom7731]

This was really helpful and helped my understanding of the topic tremendously. Thank you =D

[@muhammadalikhan6474]

Crystal clear concept Thanks

[@reemaanjum1370]

Thank you so much

[@user-om9es4co6c]

great video, thank you

[@user-vi2tc3eb5o]

great one!

[@eagleeye9549]

I have had two lower decompressions and ended up with CES both times and it sucks! I Lost control of my bladder and bowels the second time and had to learn to sit up and walk with a lot of of pain! And it's been almost six months and self-catheterization and shitting myself several times a day. I'm praying that it will get better. The first time just the numbness in the saddle area. After watching this video I am deducing that I have both...

[@melofficial97]

GREAT explanation. thank you

[@tharikaneelawathura7240]

Very well explained ❤

[@vijayanand2211]

Awsme explanation... loved it

[@sapnapk7501]

Wonderful,clear explanation.thank u.

[@ajitmadhual1511]

Awesome explanation

[@docdiaries8866]

Thank you..!!

[@aamir7790]

in month of Dec2019 ,I faced CES surgery , but now some portion of lower back ,sensory do not working still..can any expert guide to recover this ,

[@novu16]

why does cms not affect lumbar plexus if cms is part of spinal cord then a lesion there would be upper motor and should have loss of function below cms which includes both lumber and sacral, can some one explain pls

[@thisisnotreal2211]

Great , thank you so much ❤️❤️❤️

[@MedMessyNotes]

You're welcome!

[@janecope6434]

I've had back pain for 5 years its now effecting my legs, there in a lot of pain when i walk will it be my spine making them painful

[@uttambhatta95]

thanks a lot....

[@Dr-Shlomo-Cohen]

If caudal equina is peripheral nerves and not cns, how do we explain the fact that its before ganglion (synapses) after the foramina?

[@step_zero]

very nice !

[@tinacollins943]

I have L5S1 and 6 I can’t hold my bowels or urine my discs burst backward and severed my nerves is this why I have this problem

[@musfirahfareed968]

best explanation

[@Purple_Med]

Thank youuuu

[@ninagraceacosta6606]

What can i do to regain my bladder and bowel...cause of Conus Modullaris syndrome

[@bruceb4679]

How can I contact you ? I’m sure I have Cauda Equina , very concerned and doctors are not !!! I need help please!

[@Moonzari]

I was diagnosed with Cauda Equina Syndrome and am now relearning to walk and have complete paralysis in my feet. No feeling in my saddle area, trouble with my bladder and bowel. It’s serious. I ignored symptoms for so long until I had lost complete function and it became a surgical emergency. Get help before you get to that point.

[@foxfur8327]

The problem is that no neurologist wants to do the operation because they fear it will make things worse (if there is such a thing as worse, ) but they will give you opiods for the rest of your life.

[@albanymountainhomestead]

@@foxfur8327 if opioids improve a patient's quality of life, then it's a risk patients are willing to live with, since nerve damage is permanent.

[@mgreene011]

@@albanymountainhomestead I believe that I had Cauda Equia but it was missed. I have very little feeling in my testicles and my feet hurt all the time.Stretching has helped and strengthening my core has helped, but I still have pain during ejaculation and can feel Nothing on the right side of my genitals. My butt is also pretty numb.

[@albanymountainhomestead]

@@mgreene011 I'm sorry your hurting, I have painful numbness from my upper ribs to my toes (half of my body) so I understand your pain. I hope you find relief soon.

[@mgreene011]

@@albanymountainhomestead Thank you. And you as well.

[@yelyab1]

Impacted how? Arthritis, bulging disk, swollen spinal cord? What is causing the the symptoms when more than one is present in imaging? When patient is in pain why isn’t pain medication given to allow mobility instead of spinal injection as a primary treatment which is not very effective and cannot be used to facilitate a normal daily routine. Are patients with this syndrome expected to suffer as a contribution to the opioid crisis?

[@benda-annevanniekerk6833]

Just confused because aren’t S1 and S2 dermatomes going to be affected in conus medullaris - so then technically there would be lower limb sensory loss in those dermatomes?!

[@ankitshrivastava5655]

Sir, 2 months back, i generated symptoms like...needling in genital part and in buttocks. At the same time, i had problem with erection and proper control on peeing. By proper control on peeing, i mean i was able to retain the pee and release it but in releasing, in the last, i had no control to jerk the pee out of body. The symptoms were gone in 3-4 days then. But since 4 days, the symptoms appeared again. I have needling in genital part, erection problem and not proper flow of urine with burning sensation. Is it a sign of cauda equina syndrome?

[@prateekbali4396]

this dude gotta be trollin

[@10thtan]

you're a champ

[@MedMessyNotes]

No, no. You're the champ!

[@bangpinkfandom1105]

When ever i watch this vlog regarding spinal disorders i became very stressed and depressed because i have some kind of spine ailment. I saw this vlog by mistake.

[@fatimamajid9870]

A fantastic explanation !! You mad it so much easy thank you .. but The bulbocavernosus reflex (S2-S4) is absent in conus medullaris syndrome !!! You said it preserved how ???

[@MedMessyNotes]

The presence of a bulbocavernosus reflex (BCR) is indicative of an intact S2-S4 spinal reflex. Moreover, an absent BCR indicates a LMN lesion while an intact BCR indicates an UMN lesion (if you're differentiating between UMN and LMN lesions because an intact BCR is obviously normal). So cauda equina will have an absent BCR if the sacral segments are impacted since it is a LMN pathology. Conus medullaris can have a preserved BCR since it has UMN in addition to LMN. So, while it is not cut and dry, conus medullaris is more likely to show a preserved BCR while cauda equina is more likely to show a diminished BCR.

[@fatimamajid9870]

Dr. My Messy Notes that was so much clarified .. thank you for the answering :)

[@hedayaalmilad7186]

@@MedMessyNotes but the bulbocavernous reflex is polysynaptic. It is absent in both UMN and LMN lesions.

[@MedMessyNotes]

pubmed.ncbi.nlm.nih.gov/29423307/

[@DougKremer]

The BCR is reflex arc is fully contained in the lower cord, CES breaks it, but CMS happens above it.

[@kalac6178]

Hii im confused about the part where the cauda equina syndrome affects lumbosacral roots while conus medullaris syndrome affects sacral cord segments and roots. Can anyone help to clarify this? thanks!

[@aakashchoudhary8181]

Clara C conus medullaris is involving sacral part of spinal cord (distal most part) so will involve only sacral nerves exiting from there. In cauda equina, both lumbar and sacral nerves are involved (not the spinal cord part, only nerves thatswhy asymmetrical too).

[@kalac6178]

thanks!

[@sosunbakr1217]

AAKASH CHOUDHARY cauda equina could be in trokal nerves?

[@dr.noir27]

bulbocavernous decreases in ces , just like other reflexes such patellar , ankle, detrusor , cremastric !!

[@josipag2185]

Good job, wish you explaind just a bit more abiut etiology mention the key thing as reflexes are that can be distinguish more objetive in radiculopathy and in general and because of forming plexus other things are overlaping always, that achiles reflex is missing and patelar reflex is there in conus syndrome. Also, bilateral like you said, in real life is not always simetrical due to its etiology and well it is not complete medular section nor hemisection - also it can cause also sensory sistem disociation loosing TA, but like you said perfect comes in the test only.

[@Fakhrihilmi69]

i dont understand why CES is a medical emergency when other upper lesions ie thoracic myelopathy which can cause more devastating results are not an emergency. please help!

[@ther1224]

Because if not treated immediately, it can cause incontinence or permanent paralysis. With regards to other UMNL, it will depend on the severity. if severe enough then it willl be considered a medical emerg. For thoracic myelopathy, what is the cause? And how severe? If the compression is little, then iit can’t be considered a medical emergency yet. I think it will depend on the presentation. Perform your quadrant scan, and based from your clinical findings and reasoning, decide on what next step is the best to do. (Refer back to physician, or emerg, continue conservative tx? )

[@Ri-yf5oq]

Crystal clear

[@anmolshah5653]

Good effort Just wanted to clarify isn't bulbocavernosus superficial reflex ? Shouldn't it be absent in both? Plz correct me if wrong!!!

[@MedMessyNotes]

I answered this somewhere else in this comment section if you scroll through, but in a nutshell: A diminished or absent BCR means that there is a LMN lesion. CES will show an absent BCR (if the lesion is in the sacral segments). However, while CMS may show an absent BCR, it is more likely than CES to show a preserved BCR due to the possibility of having a an isolated UMN lesion. So, on an exam, if there is ever a preserved BCR, the answer is likely to be CMS. BCR should not be your lifeline though. You will have other clues.

[@anmolshah5653]

Thnxx Dr . I tried to go by the Golden rule that superficial reflexes are always absent be it LMN or UMN. Thnxx for the reply sir.

[@abu-farhanrizvi1278]

Fantastic video ,,,,,DR RIZVI

[@frankfromupstateny3796]

So what does one do...whose been trying to "talk the talk for 20 years to physicians" about sexual numbness, bowel weaknesses,...etc? I feel like I'm talking to the "living dead" when discussing this...it's tough to do "in it's own right"...but physicians think I'm crazy?

[@foxfur8327]

Yes, as with most everyone with this screaming spinal pain and inability to have a bowel movement more than once everyy 7 to 8 days without so much laxative it makes you violently ill. You might try to ask for a colostomy bag if you have no desire whatsoever to go and have severe 24 hour spinal and leg pain. I have never seen any solution to trigger the muscles that people need in order to be able to go, so most will suffer with extreme pain for many years. Another alternative will be that you will unexpectedly fill your pants from both ends when you go out. More doctors will understand when they themselves start doing this in front of their..patients.

[@albanymountainhomestead]

I too have the numbness to my female parts, which has little sensation.

[@abyss8501]

use large and visible pointer..

[@morgancalvi6675]

You're saying where things are...but not showing anything.But based on the comments, others seemed to get it. Am I missing something?

[@MedMessyNotes]

Yea, I am showing it. Sorry that it's hard to see in this video. Try to look closely and you'll see it.

[@morgancalvi6675]

@@MedMessyNotes I got it....

[@DougKremer]

I'm developing symptoms of CESS from a L4/L5 central disc extrusion 12 years ago. I go to a Urologist to get everything in their realm checked out for exclusionary reasons. I explained whats going on, what I think it is, and we decide to do a full exam, for the first time ever in my life at 45. First pass is all good, then he thinks for a minute and says "I want to check some reflexes but I don't want to tell you what they are first because it might spoil the results, can you trust me and just go with it?" "Sure Doc" *BC reflex test stimulus*, pause, "hrmm" from him. *BC reflex test stimulus* multiple times. "hrmm" from him again. Me: "Are you expecting some sort of clown nose honk?" Dr: big laugh and he asks me to stand back up and then he explains the test and how I failed miserably, and that he is very concerned.

[@mello57]

bn

[@rathasasnwridiman3483]

wow bad hand writing but really great content