Incomplete Spinal Cord Syndromes

Question 1

hemisection of the spinal cord

Answer 1

Brown-Séquard syndrome

Question 2

Ipsilateral →
Loss of proprioception, vibration, and tactile (fine touch) discrimination below the level of the lesion
Loss of motor & + Babinski

Contralateral →
Loss of pain, temperature, and non-discriminative touch (crude touch) sensation one or two levels below lesion

Diagnosis?

Answer 2

Brown-Séquard syndrome

Hemisection of spinal cord

Question 3

Brown-Séquard syndrome presents with

Ipsilatreral loss of:
Contralateral loss of:

Answer 3

Ipsilatreral:

• Propio/vibration/fine touch (1 lvl below)
• Motor

Contralateral:
-Pain/Temp/crude touch (1 lvl below)

Question 4

Damage to the anterior two-thirds of the spinal cord, usually as a result of reduced blood flow or occlusion to the _____ artery

Answer 4

anterior spinal artery (ASA)

anterior spinal artery syndrome

Question 5

Anterior Apinal Artery Syndrome 
can be iatrogenic after:
spinal angiography
spinal anesthesia
[type of surgery]

other causes:
Aortic dissection/Aneurysm
Severe hemorrhage/ Trauma
Hyperflexion injury 
Thrombosis

Answer 5

(s/t Adamkiewicz lesion: a radicular/ intercostal branch)

*Mid-thoracic ASA territory is a watershed area because the artery of Adamkiewicz is the only major vessel that supplies it

Question 6

In anterior spinal artery syndrome

____ are typically spared because of an intact dorsal column.

Answer 6

Vibration & proprioception

Question 7

Bilateral loss of vibration, proprioception, and fine touch below the lesion

Etiology:
Multiple sclerosis
Friedreich ataxia

Artery & Associated syndrome?

Answer 7

Posterior Spinal Artery
(Posterior cord syndrome)

*Etiology: Tabes dorsalis (3º syphilis)

Question 8

Elderly patient pmh of spinal degenerative changes s/p trauma, whiplash or hyperextension injury complains of:
Bilateral motor paresis/weakness in arms/hands
(upper > lower extremities)
(distally > proximally)
&
Variable sensory impairment:
- Burning pain in the arms
- Loss of temperature & pain in the arms

Diagnosis?

Answer 8

Central cord syndrome

*Other Etiologies: Syringomyelia, Cervical spondylosis, Traumatic disk herniation

Question 9

best confirmatory test for suspected Anterior Spinal Artery Syndrome or PSAS?

Answer 9

Spinal MRI

if ASAS s/t thrombosis give Aspirin

Question 10

If pt has PSAS get [labs] if syphilis suspected

Answer 10

VDRL or RPR

Question 11

if Brown-Séquard syndrome, consider:

[imaging] if trauma
[imaging] if a tumor is suspected

Answer 11

CT

MRI

Question 12

best confirmatory test for suspected central cord syndrome?

Answer 12

CT

and/or

MRI

Question 13

Presents with:
Spinal shock
Bilateral loss of temperature and pain sensation (below level of lesion)
flaccid paralysis (at level of & below lesion)
Bladder, Bowel, & Sexual dysfunction
Othostatic hypotension
Absent bulbocavernosus reflex

Answer 13

Anterior Spinal Artery Syndrome

*bulbocavernosus reflex (anal sphincter contraction in response to squeezing the genitalia or tugging on Foley)