SCI Syndromes

Question 1

List SCI Syndromes

Answer 1

1. Anterior Cord Syndrome
2. Central Cord Syndrome
3. Brown-Sequard Syndrome
4. Cauda Equina
5. Conus Medullaris Syndrome

Question 2

what is the cause and common MOIs for anterior cord syndrome?

Answer 2

1. Causes
   
   • damage to cord itself
   • damage to anterior spinal artery
   • all of the above
2. Common MOI
   
   • flexion injuries
   • burst frxs

Question 3

clinical presentation of anterior cord syndrome

Answer 3

Bilateraly loss of motor function and pain/temp below level of injury

Question 4

T/F: medial lemniscus tracts are damaged with anterior cord syndrome

Answer 4

FALSE

they remain intact

Question 5

what is the most common SCI syndrome?

Answer 5

central cord syndrome

9% of all traumatic SCI injuries

Question 6

what is central cord syndrome?

Answer 6

damage to central aspect of spinal cord

occurs almost exclusively as a cervical injury

Question 7

Central Cord syndrome is more common in what populations/age groups?

Answer 7

1. Elderly → prior spondylosis or stenosis
   
   • typically due to extension injury
   • often results with relatively minor trauma, often w/o vertebral trauma
2. Younger populations → flexion + compression
   
   • +vertebral trauma
   • herniated disc

Question 8

clinical presentation of central cord syndrome

Answer 8

1. UE >> LE involvement
2. sparing sacral sensation, may have sparing of sacral motor

Question 9

describe why central structures may be injuried with central cord syndrome

Answer 9

2 different hypotheses:

1. severe extension moment crunches center of cord causing more necrosis
2. general extension movements invovled in injury may result in specific pattern of ischemia, necrosis and edmea that doesn’t travel to the periphery

Question 10

what is brown-sequard syndrome?

Answer 10

damage to only one side of the cord

relatively uncommon (1-4% of traumatic SCIs)

Question 11

what are some potential causes of brown-sequard syndrome?

Answer 11

knife or gunshot wound

resulting in hemi-section or incomplete injury

Question 12

clinical presentation of brown-sequard syndrome

Answer 12

depends on level of injury but generally:

1. ipsilateral motor and dorsal column symptoms
   
   • motor
   • touch, proprioception, 2-pt discrimination
2. contralateral anterolateral pathway symptoms
   
   • pain and temperature
3. ipsilateral spasticity common below level of lesion

Question 13

how common is posterior cord syndrome?

Answer 13

extremely rare (<1% of traumatic SCIs)

Question 14

cause of posterior cord syndrome

Answer 14

results from

1. compression by disc or tumor
2. PSA infarct
3. vitamin B12 deficiency

Question 15

clinical presentation and prognosis for posterior cord syndrome

Answer 15

1. dorsal column lost bilaterally below level of lesion
2. motor and pain/temp preserved
3. prognosis → typically respond well to rehab

Question 16

Prognosis for anterior cord syndrome

Answer 16

1. Extremely poor for
   
   • bowel and bladder function
   • hand function
   • ambulation
2. 10-20% chance of motor recovery
   
   • even with those with some recovery, demo poor power and coordination

Question 17

Prognosis for central cord syndrome

Answer 17

1. Most ppl will regain some level of ambulatory function
   
   • becomes more disproportionate w/older pts (90% vs 41%)
2. >50% will recover bowel and bladder control
3. Intrinsic hand function last to return
   
   • <50% may demo return of hand function

Question 18

List postive prognostic factors for central cord syndrome

Answer 18

1. good hand function
2. evidence of early motor recovery
3. young age
4. absense of spasiticity
5. pre-injury employment
6. absence of LE neurologic motor impairment at rehab admission

Question 19

Prognosis ffor brown-sequard syndrome

Answer 19

1. generally very good
2. nearly all pts will attain some level of ambulatory function
3. 80% regain hand function
4. 100% regain bladder control, 80% bowel control

Question 20

list the general mechansim of each SCI syndrome

Answer 20

1. Anterior → flexion or vasculature
2. Central → forced hyperextension
3. Brown-Sequard → penetrating trauma

Question 21

brief clinical description of Anterior Cord Syndrome

Answer 21

1. complete loss of motor, pain, and temp below injury
2. retains proprioception and vibratory sensation
3. Prognosis → POOR

Question 22

brief clinical description of Central Cord Syndrome

Answer 22

1. Sensory and motor deficit UE >> LE
2. Prognosis → AVERAGE

Question 23

brief clinical description of Brown-Sequard Syndrome

Answer 23

1. Ipsilateral loss of motor, vibration, and proprioception
2. Contralateral loss of pain, and temp
3. Prognosis → GOOD

Question 24

what is conus medullaris syndrome?

Answer 24

damage to sacral cord and lumbar nerve roots

Question 25

common causes of conus medullaris syndrome

Answer 25

1. trauma 2. tumors 3. infections 4. stenosis

Question 26

Conus Medullaris symptoms

Answer 26

1. **Symmetrical saddle anesthesia** - more localized perianal 2. **Symmetrical** weakness/flaccidity 3. possible hypertonicity 4. Distal LE (ankle) areflexia 5. Sexual dysfunction 6. Mild LBP w/potential mild radicular symptoms * more pain noted in perianal region 7. Bowel and bladder dysfunction * typically urinary retention and atonic anal sphincter

Question 27

T/F: you may see intact sacral reflexes in Conus Medullaris Syndrome

Answer 27

TRUE

Question 28

Conus Medullaris Syndrome Treatment

Answer 28

surgical decompression

Question 29

what is cauda equina syndrome?

Answer 29

injury below L1 to lumbosacral roots of peripheral nerves making this a LMN INJURY \*\*the spinal cord is spared

Question 30

common causes of cauda equina syndrome

Answer 30

1. lumbar burst frx 2. herniated disc can be acute or chronic presentation

Question 31

T/F: incomplete lesions in cuada equina syndrome are rare

Answer 31

FALSE they are common since damage to nerve roots is highly variable

Question 32

Cauda Equina Symptoms

Answer 32

can be gradual onset or acute 1. Common triad * **asymmetrical** saddle anesthesia * bowel and/or bladder dysfunction * **asymmetrical** LE weakness 2. variable sensory loss 3. flaccid paralysis, areflexia * including loss of sacral reflexes 4. flaccid paralysis of bowel and bladder 5. severe LBP, often with severe radicular pain

Question 33

treatment for cauda equina syndrome

Answer 33

surgical decompression

Question 34

T/F: there may be nerve regeneration with cauda equina syndrome

Answer 34

TRUE however regeneration is often incomplete tends to plateau after 1 year

Question 35

Prognosis for cauda equina syndrome

Answer 35

1. bladder outcomes worsen the longer the cauda equina is compressed 2. prognosis improves when surgery occurs within 48 hours of initial presentation 3. due to potential for regeneration, more favorable prognosis for functional recovery compared to UMN SCI syndromes

Question 36

Prognosis for conus medullaris syndrome

Answer 36

1. similar prognostic indicators as cauda equina but since UMN involvment, the prognosis is less favorable * 10% regain function