Spinal cord syndromes

Question 1

Hemicord syndrome

(Brown-Sequard paralysis) - cause and features?

Answer 1

cause:
- Penetrating injury
- Extrinsic compression

features:
- Contralateral spinothalamic loss
- Ipsilateral paresis
- Ipsilateral dorsal column loss
- Preserved light touch

Note: deficits appear one to two levels below injury

Question 2

Anterior cord syndrome - cause and features?

Answer 2

cause:
- Anterior spinal artery infarct
- “Watershed” (T4-T6) ischemia
- Acute cervical disk herniation

features:
- Bilateral spinothalamic loss
- Preserved dorsal column
sensation
- Upper motor neuron paralysis below lesion
- Lower motor neuron paralysis at lesion
- Sphincter dysfunction

Question 3

Central cord syndrome - cause and features?

Answer 3

cause:
- Syringomyelia
- Hypotensive spinal cord ischemia
- Spinal trauma (flexion-extension injury)
- Spinal cord neoplasm
- Sphincter dysfunction or
urinary retention

features:
- Lower motor neuron weakness in arms
- Variable leg weakness and spasticity
- Severe pain and hyperpathia
- Spinothalamic loss in arms

Question 4

Posterior cord syndrome - cause and features?

Answer 4

cause:
- Trauma
- Posterior spinal artery infarct

features:
- Dorsal column sensory loss
- Pain and paresthesias in
neck, back, or trunk
- Mild paresis