Spinal Cord Lesions

Question 1

Complete spinal cord syndrome - cervical cord

Answer 1

• Can result from trauma, degenerative disease, inflammation, infection or tumour
• All descending motor and ascending sensory tracts disrupted
• Motor - spastic tetraparesis
• Reflexes - brisk below level of lesion
• Sensory - loss of all modalities below lesion
• Plantars - extensor response bilaterally
• Breathing - affected in high cervical lesions
• Remember spinal shock and sphincter disturbance

Question 2

Complete spinal cord syndrome - thoracic cord

Answer 2

• Can result from trauma, degenerative disease, inflammation, infection or tumour
• All descending motor and ascending sensory tracts disrupted
• Motor - spastic paraparesis
• Reflexes - brisk in lower limbs
• Sensory - loss of all modalities below lesion
• Plantars - extensor response bilaterally
• Breathing - not affected
• Remember spinal shock and sphincter disturbance

Question 3

Cauda equina syndrome

Answer 3

• Most commonly results from lumbar disc herniation
• Can result from trauma, epidural haematoma, infection or tumour
• Presents with:
  
  • Lower back pain
  • Saddle and/or genital sensory disturbance
  • Bladder/bowel/sexual dysfunction
• Motor - flaccid paraparesis
• Reflexes - lower limb reflexes absent
• Sensory - saddle anaesthesia, lower limbs - variable sensory deficit
• Plantars - flexor response

Question 4

Brown-Sequard syndrome

Answer 4

• Hemi-section of the cord
• Affects LCT, DC and LST
• Can result from trauma, degenerative disease, inflammation, infection or tumour
• Motor - ipsilateral spastic hemi-/mono-paresis
• Reflexes - ipsilateral brisk reflexes
• Sensory - loss of light tough, vibration and proprioception on ipsilateral side; loss of pain and temperature on contralateral side
• Plantars - ipsilateral extensor response
• Breathing - hemi-diaphragmatic weakness in high cervical cord lesions only

Question 5

Posterior column pathology

Answer 5

• Some pathologies selectively affect posterior columns:
  
  • Vitamin B12 deficiency
  • Tabes dorsalis
  • Vitamin E deficiency
  • Friedreich’s ataxia
• Clinical presentation:
  
  • Loss of vibration and proprioception
  • Sensory ataxia
  • Positive Romberg sign

Question 6

Anterior horn cell syndromes

Answer 6

• Motor neurone disease
• Peak incidence at 60-70 years, men > women
• Clinical presentation
  
  • Asymmetric limb weakness
  • Bulbar symptoms
  • Subgroup have cognitive impairment (FTD pattern)
• Pathology
  
  • Degeneration of anterior horns of the spinal cord/cranial nerve motor nuclei
  • Degeneration of corticospinal/corticobulbar tracts
• Diagnosis clinical but supported by EMG changes
  
  • Denervation in muscles supplied by more than one spinal region
• Examination features
  
  • UMN and LMN signs
• Prognosis
  
  • Mean survival 2-3 years
• Motor - spastic tetraparesis, wasting/fasciculations in tongue/limbs/intrinsic hand muscles +/- bulbar/pseudobulbar weakness
• Reflexes - pathalogically brisk
• Sensory - normal
• Plantars - extensor response
• Breathing - usually unaffected

Question 7

Subacute combined degeneration of the spinal cord (vitamin B12 and E deficiency)

Answer 7

• Affects LCT, DC and SCT
• Motor - bilateral spastic paresis, bilateral limb ataxia
• Sensory - bilateral loss of proprioception and vibration sensation

Question 8

Friedrich’s ataxia

Answer 8

• Affects LCT, DC and SCT
• Motor - bilateral spastic paresis, bilateral limb ataxia + cerebellar features
• Sensory - bilateral loss of proprioception and vibration sensation

Question 9

Anterior spinal artery occlusion

Answer 9

• Affects LCT and LST
• Motor - bilateral spastic paresis
• Sensory - bilateral loss of pain and temperature sensation

Question 10

Syringomyelia

Answer 10

• Affects VH and LST
• Motor - flaccid paresis (typically affecting intrinsic hand muscles)
• Sensory - bilateral loss of pain and temperature sensation

Question 11

Neurosyphilis (tabes dorsalis)

Answer 11

• Affects DC
• Sensory - loss of proprioception and vibration sensation