Objective

This study aims to describe the clinical features and outcomes of patients with isolated infarctions of the conus medullaris, and to identify factors associated with poor functional outcomes.

Materials and methods

We performed a systematic review and retrospective analysis on the clinical characteristics and outcomes of patients with isolated conus medullaris infarctions reported in literature over the past 30 years.

Results

We analyzed a total of 19 cases; 18 identified in literature from January 1991 to June 2021, together with our patient. Their median age was 56 years (range 28–79), with twice as many females as males. Pain was prominent at onset (15/19, 79%), only a third had vascular risk factors (7/19, 37%), and half had no significant preceding activities or events (9/19, 47%). Almost all experienced paraplegia or paraparesis (16/19, 84%), in which upper motor neuron features were rare (3/19, 16%). The underlying cause was unknown in half (10/19, 53%). Functional outcomes appeared fair, with nearly half being capable of unassisted ambulation (9/11, 82%). Patients with vascular risk factors (67% vs 13%, p = 0.024) or with identified underlying causes (78% vs 13%, p = 0.007) were less likely to walk unassisted.

Conclusion

Isolated conus medullaris but should be considered in patients with acute cauda equina syndrome, especially in females. Patients with vascular risk factors, or with known causes of infarction, are less likely to walk unassisted. DWI sequences should be included in conventional MRI sequences when evaluating patients with acute cauda equina syndrome.

中文翻译：

---

孤立性脊髓圆锥梗塞：临床特征和结果

目标

本研究旨在描述孤立性脊髓圆锥梗死患者的临床特征和预后，并确定与功能预后不良相关的因素。

材料和方法

我们对过去 30 年文献中报道的孤立性脊髓圆锥梗死患者的临床特征和结果进行了系统回顾和回顾性分析。

结果

我们共分析了 19 个案例；从 1991 年 1 月到 2021 年 6 月，文献中确定了 18 名，以及我们的患者。他们的中位年龄为 56 岁（28-79 岁），女性人数是男性的两倍。疼痛在开始时很明显 (15/19, 79%)，只有三分之一有血管危险因素 (7/19, 37%)，一半没有显着的既往活动或事件 (9/19, 47%)。几乎所有人都经历过截瘫或下肢轻瘫 (16/19, 84%)，其中上运动神经元特征很少 (3/19, 16%)。一半 (10/19, 53%) 的根本原因未知。功能结果似乎是公平的，近一半能够独立行走（9/11，82%）。具有血管危险因素（67% 对 13%，p  = 0.024）或已确定潜在原因（78% 对 13%，p = 0.007) 不太可能独立行走。

结论

孤立的脊髓圆锥，但应考虑用于急性马尾综合征患者，尤其是女性。有血管危险因素或已知梗塞原因的患者不太可能独立行走。在评估急性马尾综合征患者时，DWI 序列应包括在常规 MRI 序列中。