Cornus medullaris SD / Cauda equina SD

Table 1. Symptoms and Signs of Conus Medullaris and Cauda Equina Syndromes

	Conus Medullaris Syndrome	Cauda Equina Syndrome
척추 레벨	L1-L2	L2-sacrum
척수 레벨	sacral cord segment (conus and epiconus) 와 roots의 손상	Ilumbosacral nerve roots의 손상
증상발현	갑자기, 양측성	점진적, 단측성
반사	Knee jerks preserved ankle jerks affected Areflexic lower extremities (If the epiconus is involved, patellar reflex may be absent, whereas bulbocavernosus reflex may be spared.)	Both ankle and knee jerks affected Areflexic lower extremities; bulbocavernosus reflex is absent in low CE (sacral) lesions
증상과 징후의 심각성	대개 심각하지 않음	대개 심각함
증상과 징후의 대칭성	대개 대칭적	대개 비대칭적
통증	대개 항문주위에 양측성 통증	Prominent, asymmetric, and radicular
Radicular pain	덜 심각함	심함
요통	더 심함	덜 심함
감각 증상과 징후	감각저하 증상은 항문주위에 좀더 국한됨; 대칭적이고 양측성 ; sensory dissociation occurs 대칭적 saddle distribution Pin prik / 온도 감각 저하 촉각은 보전	감각저하증상은 saddle area에 좀 더 국한됨; 비대칭적, 단측성일 수 있음. ; no sensory dissociation; 하지의 특정 dermatome에 감각둔마 및 저림 페니스나 클리토리스를 포함한 pubic area에 감각저하 가능 Saddle anesthesia, may be asymmetric
근력	전형적으로 대칭적인 hyperreflexic distal paresis of lower limbs that is less marked; fasciculations may be present 정상적 또는 경증~중등증의 위약	비대칭적 areflexic paraplegia that is more marked; fasciculations rare; atrophy more common Weakness to flaccid paralysis (상당한 근력저하)
발기부전	흔하다	덜 흔하다; erectile dysfunction that includes inability to have erection, inability to maintain erection, lack of sensation in pubic area (including glans penis or clitoris), and inability to ejaculate
괄약근 기능	Urinary retention and atonic anal sphincter cause overflow urinary incontinence and fecal incontinence; tend to present early in course of disease Early and severe bowel, bladder, and sexual dysfunction that results in a reflexic bowel and bladder with impaired erection in males	Urinary retention; tends to present late in course of disease Usually late and of lesser magnitude; lower sacral roots involvement can cause bladder, bowel, and sexual dysfunction
EMG	Mostly normal lower extremity with external anal sphincter involvement	Multiple root level involvement; sphincters may also be involved
Outcome	The outcome may be less favorable than in patients with CES	May be favorable compared with conus medullaris syndrome

Table 2. Pain and Deficits Associated with Specific Nerve Roots

Nerve Root	Pain	Sensory Deficit	Motor Deficit	Reflex Deficit
L2	Anterior medial thigh	Upper thigh	Slight quadriceps weakness; hip flexion; thigh adduction	Slightly diminished suprapatellar
L3	Anterior lateral thigh	Lower thigh	Quadriceps weakness; knee extension; thigh adduction	Patellar or suprapatellar
L4	Posterolateral thigh, anterior tibia	Medial leg	Knee and foot extension	Patellar
L5	Dorsum of foot	Dorsum of foot	Dorsiflexion of foot and toes	Hamstrings
S1-2	Lateral foot	Lateral foot	Plantar flexion of foot and toes	Achilles
S3-5	Perineum	Saddle	Sphincters	Bulbocavernosus; anal

Table 3. Root and Peripheral Nerve Innervation of the Lumbosacral Plexus

Muscle	Nerve	Root
Iliopsoas	Femoral	L2, 3, 4
Adductor longus	Obturator	L2, 3, 4
Gracilis	Obturator	L2, 3, 4
Quadriceps femoris	Femoral	L2, 3, 4
Anterior tibial	Deep peroneal	L4, 5
Extensor hallucis longus	Deep peroneal	L4, 5
Extensor digitorum longus	Deep peroneal	L4,5
Extensor digitorum brevis	Deep peroneal	L4, 5, S1
Peroneus longus	Superficial peroneal	L5, S1
Internal hamstrings	Sciatic	L4, 5, S1
External hamstrings	Sciatic	L5, S1
Gluteus medius	Superior gluteal	L4, 5, S1
Gluteus maximus	Inferior gluteal	L5, S1, 2
Posterior tibial	Tibial	L5, S1
Flexor digitorum longus	Tibial	L5, S1
Abductor hallucis brevis	Tibial (medial plantar)	L5, S1, 2
Abductor digiti quinti pedis	Tibial (lateral plantar)	S1, 2
Gastrocnemius lateral	Tibial	L5, S1, 2
Gastrocnemius medial	Tibial	S1, 2
Soleus	Tibial	S1, 2

원인

Intrinsic tumor

infarction

Extrinsic cord compression

척수경색

척수원뿔경색은 3가지의 형태로 분류할 수 있다. T9 전척수동맥의 혈류저하에 의한 것은 척수원뿔의 말단부위의 경색이 생기며, L1 후척수동맥의 혈류저하에 의한 것은 척수원뿔의 근위 부위의 경색이 생기고, 전신적인 혈류저하에 의한 것은 척수원뿔 전체에 경색이 생기는 것으로 알려져 있다

출처: <http://jkna.org/journal/view.php?number=6512>