Incomplete spinal cord injuries

Question 1

List 4 types of incomplete spinal cord syndromes

Answer 1

Central cord syndrome (most common)
Anterior cord syndrome
Posterior cord syndrome
Brown-Sequard syndrome

Question 2

What is central cord syndrome?

Answer 2

Injury to the central region of the spinal cord (central corticospinal tracts + decussating fibers of lateral spinothalamic tract)

Question 3

List 5 causes of central cord syndrome

Answer 3

Syringomyelia
Degenerative spine disease
Cervical spondylosis
Traumatic disk herniation
Various hyperextension injuries

Question 4

3 clinical features of central cord syndrome

Answer 4

Bilateral motor paresis (upper > lower extremities; distally > proximally)
Variable sensory impairment: Burning pain in arms, loss of pain + temperature in arms
Sacral sparing

Question 5

Ix for central cord syndrome

Answer 5

CT +/or MRI
to determine location, cause, + extent of neurological damage

Question 6

Define anterior spinal cord syndrome

Answer 6

Damage to anterior 2/3 of spinal cord, usually as a result of reduced blood flow or occlusion to anterior spinal artery (ASA) → anterior spinal artery syndrome

Question 7

List 5 cause of anterior spinal cord syndrome

Answer 7

Systemic hypo perfusion (HF)/ hypotension
Iatrogenic e.g. in aortic surgery
Arteriosclerosis
Aortic dissection
Trauma

Question 8

Describe the acute clinical features of anterior spinal cord syndrome

Answer 8

Within hours
Back or chest pain
Spinal shock

Question 9

Describe 4 late clinical features of anterior spinal cord syndrome

Answer 9

Continued sensory + autonomic dysfunction

UMN dysfunction (spastic paraparesis or quadriparesis) below level of lesion due to damage to corticospinal tracts

LMN deficits (flaccid paralysis) at level of lesion due to damage to the anterior horn

Hyperreflexia

Question 10

Which sensory modality is usually spared in anterior spinal cord syndrome?

Answer 10

Vibration + proprioception
because of an intact dorsal column

Question 11

Ix for anterior spinal cord syndrome

Answer 11

Spinal MRI
Detects spinal cord parenchyma abnormalities

Question 12

Define posterior spinal cord syndrome

Answer 12

Injury of posterior spinal cord affecting posterior column (fine touch, vibration, pressure + proprioception)

Question 13

List 5 causes of posterior spinal cord syndrome

Answer 13

Occlusion of posterior spinal artery
Multiple sclerosis
Tabes dorsalis
Subacute combined degeneration
Friedreich ataxia

Question 14

Describe the clinical features of posterior spinal cord syndrome

Answer 14

Bilateral loss of vibration, fine touch + proprioceptive sensation below the lesion

Question 15

Ix for posterior spinal cord syndrome

Answer 15

MRI showing infarction of dorsal columns in cases of posterior spinal artery occlusion

Question 16

Define Brown Sequard syndrome

Answer 16

hemisection of the spinal cord (often in the cervical cord)

Question 17

Describe the aetiology of Brown Sequard syndrome

Answer 17

Unilateral compression commonly through trauma
Less commonly: disk herniation, spinal epidural hematoma, spinal epidural abscess (rare) or tumor, MS, complication of decompression sickness

Question 18

Describe the ipsilateral features of Brown Sequard syndrome

Answer 18

Loss of all sensation at level of lesion

Loss of proprioception, vibration + fine touch discrimination below level of lesion due to an interrupted posterior column

Segmental flaccid paresis at level of lesion due to affection of LMNs at level of lesion

Spastic paralysis below level of lesion

Babinski sign (UMN axons in lateral corticospinal tracts)

In lesions above T1, Horner syndrome occurs due to damage to ipsilateral sympathetic fibers (the oculosympathetic pathway).

Question 19

Describe the contralateral features of Brown Sequard syndrome

Answer 19

Loss of pain, temperature + non-discriminative touch (crude touch) sensation one or two levels below lesion due to an interrupted spinothalamic tract

Question 20

Ix for Brown Sequard syndrome

Answer 20

Clinical dx
Consider CT if trauma has occurred or MRI if a tumor is suspected.