Spinal Cord Syndromes

Question 1

What are the typical mechanisms of injury that can lead to anterior cord syndrome?

Answer 1

Flexion, burst fractures

Question 2

What will be the clinical presentation of a patient with anterior cord syndrome?

Answer 2

BILATERALLY Below level of injury:
* Loss of motor function
* Loss of pain/temp

Question 3

What are the typical mechanisms of injury that can lead to central cord syndrome?

Answer 3

• Elderly: Extension (typically cervical) - often minor trauma, no vertebral trauma
• Younger: Flexion + compression with vertebral trauma, herniated disc

Question 4

What will be the clinical presentation of a patient with central cord syndrome?

Answer 4

• Bilateral loss of motor function
• UE > LE
• “Upside down”
• Sparing sacral sensation, may have sparing sacral sensation

Question 5

What are the typical mechanisms of injury that can lead to Brown-Sequard syndrome?

Answer 5

Knife wound, GSW

Question 6

What will be the clinical presentation of a patient with Brown-Sequard syndrome?

Answer 6

• IPSILATERAL motor and dorsal column symptoms + spasticity
• CONTRALATERAL anterolateral symptoms

Question 7

What are the typical mechanisms of injury that can lead to posterior cord syndrome?

Answer 7

• compression from disc or tumor
• PSA infarct
• Vit B12 deficiency

Question 8

What will be the clinical presentation of a patient with posterior cord syndrome?

Answer 8

Dorsal column (LT/proprioception) lost BILATERALLY below level of lesion

Question 9

Why is posterior cord syndrome no longer recognized as an SCI syndrome by ASIA?

Answer 9

SO RARE

Question 10

What do we know about the prognosis for functional return for anterior cord syndrome?

Answer 10

• EXTREMLY poor for: bowel/bladder function, hand function, ambulation
• 10-20% chance of motor recovery

Question 11

What do we know about the prognosis for functional return for central cord syndrome?

Answer 11

• Most regain ambulatory function (except for elderly)
• > 50% regain bowel and bladder control
• Intrisic hand function last to return, but <50% may demo hand function.

Question 12

What are some known positive prognostic indicators for functional return for central cord
syndrome?

Answer 12

• Good hand function
• Evidence of early motor recovery
• Young age
• Absence of spastiscity
• Pre-injury employment
• Absence of LE neurologic motor impairment at rehab admission

Question 13

What do we know about the prognosis for functional return for Brown-Sequard
syndrome?

Answer 13

• Good prognosis
• Nearly all pt attain some level of ambulatory function
• 80% regain hand function
• 100% regain bladder control
• 80% bowel control

Question 14

What are the typical mechanisms of injury that can lead to conus medullaris syndrome?

Answer 14

trauma, tumors, infections, stenosis

Question 15

What will be the clinical presentation of a patient with conus medullaris syndrome?

Answer 15

• UMN + LMN Symptoms
• Symmetrical saddle anesthesia
• Symmetrical weakness + flaccidity
• Hypertonicity/or hypotonicity
• Distal LE areflexia (ankle); possibly intact sacral reflexes
• Sexual dysfunction
• Mild low back pain with potential mild radicular symptoms and atonic anal spincter
• Bowel and bladder dysfunction; typically urinary retention and atonic anal sphincter

Question 16

What is the typical treatment for conus medullaris and auda equina syndrome?

Answer 16

Surgical decompression

Question 17

What are the typical mechanisms of injury that can lead to cauda equina syndrome?

Answer 17

Lumbar burst fracture or herniated disc (acute or chronic presentation)

Question 18

What will be the clinical presentation of a patient with cauda equina syndrome?

Answer 18

• LMN (PNS injury, not true SCI) - cord spared
• Asymmetrical saddle anesthesia
• Bowel/bladder dysfunction
• Aymmetrical LE weakness
• Variable sensory loss
• Flaccid paralysis, areflexia (loss of sacral reflexes)
• Flaccid paralysis of bowel and bladder
• Severe low back pain often with severe radicular pain

Question 19

How do prognoses compare for conus medullaris and cauda equina syndromes?

Answer 19

Equina:
* potential for nerve regeneration (PNS), often incomplete
* Bladder outcomes worse with longer compression
* Prognosis improves when surgery w/in 48H
Medullaris:
- Similar but less favorable (10% regain function)