Clinical Reasoning: A 62-Year-Old Man With Symmetric Saddle Hypoesthesia and Sphincter Dysfunction.

A 62-year-old man presented with acute onset of symmetric burning dysesthesias in the buttocks, accompanied by saddle hypoesthesia and bladder, bowel, and sexual dysfunction. Initially, the clinical presentation was suggestive of cauda equina syndrome. However, the initial contrast-enhanced lumbar MRI revealed no evidence of extrinsic compression or enhancement of the lumbosacral nerve roots or conus medullaris. Further diagnostic workup uncovered a rare etiology, highlighting the importance of considering uncommon causes in the case of acute conus medullaris syndrome.