Nervous and mental diseases . at the distinction is often very diffi-cult. After L. R. Miiller, Bruns, Cassirer,and others we may make the following differ-ential enumeration:The caudal lesion is: (1) Of slow onset except in traumatic cases. (2)It is attended by lancinating pains and painful paroxysms in the bladder,perineal, and sciatic regions. (3) Anesthesias embracing all modalitiesof sensation are of gradual and late development and rarely of accuratelysymmetrical distribution. (4) There is an absence of spasms, rigidity,fibrillation, and increased reflexes. The condition is one of flacci
Nervous and mental diseases . at the distinction is often very diffi-cult. After L. R. Miiller, Bruns, Cassirer,and others we may make the following differ-ential enumeration:The caudal lesion is: (1) Of slow onset except in traumatic cases. (2)It is attended by lancinating pains and painful paroxysms in the bladder,perineal, and sciatic regions. (3) Anesthesias embracing all modalitiesof sensation are of gradual and late development and rarely of accuratelysymmetrical distribution. (4) There is an absence of spasms, rigidity,fibrillation, and increased reflexes. The condition is one of flaccidity,the heel, plantar, and anal reflexes are diminished or abolished, the knee-jerk is retained, there is muscular wasting in the legs, and the reactionof degeneration in severe or advanced cases. (5) A gradually advancingparesis follows the sensory symptoms. (6) At the same time w^eaknessof bladder, bowel, and sexual power develop. (7) There is frequentlytenderness over the second lumbar spine and percussion tenderness over. Fig. 129.—Area of anesthesia ina lesion of the cauda, affecting allthe sacral roots. LOCALIZATION. 361 the sacrum and lumbar region, where occasionally bony deformitiescan be detected by examination, the o^-ray, etc. (8) Remissions arefrequent. Schlesinger^ calls attention to a painful stretching symptomwhen the patient is in the sitting posture. It appears to be due to thetension put upon the caudal roots by this position. The pain is referredto the rectum, bladder, genitals, perineum, or even down the thighs^it is generally intense and persistent. The conus lesion is: (1) Usually of abrupt onset. (2) Pain is not amarked symptom and may be quite absent. (3) Anesthesias of perineal,gluteal, and pudendal regions are a common early symptom, of markedsymmetrical distribution, and frequently of the dissociation t^^De; testic-ular sensitiveness is retained. (4) Motor irritation, such as fibrillations,cramps, and rigidities, are common, but the tendon reflexe
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