You have a patient that presents with a difficulty in emptying his bowel and pro

Question

You have a patient that presents with a difficulty in emptying his bowel and problems with constipation. He also has difficulty achieving an erection. An MRI reveals a herniation of the intervertebral disc between the first and second lumbar vertebrae. Tests clearly reveal that parasympathetic output to the terminal end of the gut and to the pelvic viscera is affected. Tests reveal no loss of sympathetic output. Describe the possible locations of a lesion that could account for these problems and clearly explain how it ac- counts for the patients problems and test results.

Explanation / Answer

The above symptoms suggest cauda equina syndrome. In this type of SCI injury occurs at L2-S5 below conus medullaris. The symptoms seen are loss of bladder and bowel movements, lost reflexes, low back pain, weakness and paralysis of lower limbs, loss of sensations.

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