Incomplete spinal cord injuries Flashcards
List 4 types of incomplete spinal cord syndromes
Central cord syndrome (most common)
Anterior cord syndrome
Posterior cord syndrome
Brown-Sequard syndrome
What is central cord syndrome?
Injury to the central region of the spinal cord (central corticospinal tracts + decussating fibers of lateral spinothalamic tract)
List 5 causes of central cord syndrome
Syringomyelia
Degenerative spine disease
Cervical spondylosis
Traumatic disk herniation
Various hyperextension injuries
3 clinical features of central cord syndrome
Bilateral motor paresis (upper > lower extremities; distally > proximally)
Variable sensory impairment: Burning pain in arms, loss of pain + temperature in arms
Sacral sparing
Ix for central cord syndrome
CT +/or MRI
to determine location, cause, + extent of neurological damage
Define anterior spinal cord syndrome
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
List 5 cause of anterior spinal cord syndrome
Systemic hypo perfusion (HF)/ hypotension
Iatrogenic e.g. in aortic surgery
Arteriosclerosis
Aortic dissection
Trauma
Describe the acute clinical features of anterior spinal cord syndrome
Within hours
Back or chest pain
Spinal shock
Describe 4 late clinical features of anterior spinal cord syndrome
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
Which sensory modality is usually spared in anterior spinal cord syndrome?
Vibration + proprioception
because of an intact dorsal column
Ix for anterior spinal cord syndrome
Spinal MRI
Detects spinal cord parenchyma abnormalities
Define posterior spinal cord syndrome
Injury of posterior spinal cord affecting posterior column (fine touch, vibration, pressure + proprioception)
List 5 causes of posterior spinal cord syndrome
Occlusion of posterior spinal artery
Multiple sclerosis
Tabes dorsalis
Subacute combined degeneration
Friedreich ataxia
Describe the clinical features of posterior spinal cord syndrome
Bilateral loss of vibration, fine touch + proprioceptive sensation below the lesion
Ix for posterior spinal cord syndrome
MRI showing infarction of dorsal columns in cases of posterior spinal artery occlusion
Define Brown Sequard syndrome
hemisection of the spinal cord (often in the cervical cord)
Describe the aetiology of Brown Sequard syndrome
Unilateral compression commonly through trauma
Less commonly: disk herniation, spinal epidural hematoma, spinal epidural abscess (rare) or tumor, MS, complication of decompression sickness
Describe the ipsilateral features of Brown Sequard syndrome
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).
Describe the contralateral features of Brown Sequard syndrome
Loss of pain, temperature + non-discriminative touch (crude touch) sensation one or two levels below lesion due to an interrupted spinothalamic tract
Ix for Brown Sequard syndrome
Clinical dx
Consider CT if trauma has occurred or MRI if a tumor is suspected.
