26th June 2023

Clinical features

Signs and Symptoms	Cauda Equina Syndrome	Conus Medullaris syndrome
Pain distribution	Severe, radicular Unilateral, asymmetric Mainly in perineum, thighs, legs, back	Bilateral, symmetric over perineum and thighs
Motor loss	Gradual, unilateral Asymmetric, more marked Atrophy may occur Usually no fasciculations	Sudden, bilateral Symmetric Fasciculations may be present
Sensory loss pattern	Saddle distribution May be unilateral and asymmetric All modalities affected	Saddle distribution Bilateral, usually symmetric Dissociation of sensation
Reflex loss	Patellar and ankle reflexes may be lost	Only ankle reflex lost
Bladder symptoms	Late and less marked, can be both incontinence or urgency	Early and marked
Rectal symptoms	Late and less marked	Early and marked
Sexual function	Less marked impairment	Erection and ejaculation impaired

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