Spinal Cord Syndromes Flashcards
What are the typical mechanisms of injury that can lead to anterior cord syndrome?
Flexion, burst fractures
What will be the clinical presentation of a patient with anterior cord syndrome?
BILATERALLY Below level of injury:
* Loss of motor function
* Loss of pain/temp
What are the typical mechanisms of injury that can lead to central cord syndrome?
- Elderly: Extension (typically cervical) - often minor trauma, no vertebral trauma
- Younger: Flexion + compression with vertebral trauma, herniated disc
What will be the clinical presentation of a patient with central cord syndrome?
- Bilateral loss of motor function
- UE > LE
- “Upside down”
- Sparing sacral sensation, may have sparing sacral sensation
What are the typical mechanisms of injury that can lead to Brown-Sequard syndrome?
Knife wound, GSW
What will be the clinical presentation of a patient with Brown-Sequard syndrome?
- IPSILATERAL motor and dorsal column symptoms + spasticity
- CONTRALATERAL anterolateral symptoms
What are the typical mechanisms of injury that can lead to posterior cord syndrome?
- compression from disc or tumor
- PSA infarct
- Vit B12 deficiency
What will be the clinical presentation of a patient with posterior cord syndrome?
Dorsal column (LT/proprioception) lost BILATERALLY below level of lesion
Why is posterior cord syndrome no longer recognized as an SCI syndrome by ASIA?
SO RARE
What do we know about the prognosis for functional return for anterior cord syndrome?
- EXTREMLY poor for: bowel/bladder function, hand function, ambulation
- 10-20% chance of motor recovery
What do we know about the prognosis for functional return for central cord syndrome?
- 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.
What are some known positive prognostic indicators for functional return for central cord
syndrome?
- 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
What do we know about the prognosis for functional return for Brown-Sequard
syndrome?
- Good prognosis
- Nearly all pt attain some level of ambulatory function
- 80% regain hand function
- 100% regain bladder control
- 80% bowel control
What are the typical mechanisms of injury that can lead to conus medullaris syndrome?
trauma, tumors, infections, stenosis
What will be the clinical presentation of a patient with conus medullaris syndrome?
- 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
What is the typical treatment for conus medullaris and auda equina syndrome?
Surgical decompression
What are the typical mechanisms of injury that can lead to cauda equina syndrome?
Lumbar burst fracture or herniated disc (acute or chronic presentation)
What will be the clinical presentation of a patient with cauda equina syndrome?
- 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
How do prognoses compare for conus medullaris and cauda equina syndromes?
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)
