Isolated Conus Medullaris Infarction: Rare Cases Highlighting Diagnostic Challenges and Clinical Insights

Spinal cord infarction that exclusively affects the conus medullaris is exceptionally rare. The dominant symptoms include flaccid paraparesis, sensory deficits with or without saddle anesthesia, and neurogenic bladder, all of which mimic cauda equina syndrome. We report two cases where patients initially presented with sudden onset of leg monoparesis, sensory deficits, and voiding difficulties. Although initially suspected of having lumbosacral radiculopathy or cauda equina syndrome, they were later diagnosed with conus medullaris infarction, as evidenced by their clinical course and spine magnetic resonance imaging findings. This report provides detailed clinical information about conus medullaris infarction, supplemented by a review of the literature, to aid in the diagnosis of this condition.