Vascular syndromes or lesions of spinal cord

Question 1

What structures are damaged in acute central cervical spinal cord syndrome?

Answer 1

Medial portions of both lateral CST; ventral gray horns at cervical levels
ALS system fibers

Question 2

What deficits are in acute central cervical spinal cord syndrome?

Answer 2

Bilateral paresis or flaccid paralysis UE (CST)

Bilateral pain/temp loss of body below lesion (ALS)

Question 3

Cause and hallmark of ACCSCS

Answer 3

Hyperextension of neck. May cause damage to vertebral A, the source of anterior spinal A, or it may directly damage anterior spinal A.

Hallmark= anterior 2/3rs spinal cord ishemic. POsyerior columns ok.

Question 4

Causes of ASA thrombosis. WHere does it occur?

Answer 4

Hypotensive crises, trauma, atherosclerosis. May occur at all spinal levels, but is most common at thoracic and lumbosacral.

Question 5

Results from ASA thrombosis

Answer 5

Bilateral flacid paraplegia (if below cervical) or quadriplegia (if above cervical)
Urinary retention
Loss of pain/temp sensation (ALS)

Question 6

What is Brown Sequard and how does it come about

Answer 6

It is a functional hemisection of sc, an incomplete sc injury. May result from trauma, compression of sc by tumor or hematomas, protrusion of disk.

Question 7

Classic signs of Brown Sequard

Answer 7

1. ALS loss to CL body beginning 1-2 levels below lesion
2. IL PCML loss to body below the lesion
3. IL body paralysis below lesion (lateral CTS)

Question 8

What is syringomyelia

Answer 8

Cavitation in the central region of spinal cord in grey matter that may impinge on the anterior white commissure containing decussating ALS fibers. SYrinx most commonly seen in cervical levels at C4-5.

Question 9

Most common deficits in syringomyelia

Answer 9

1. Bilateral loss of pain and thermal sensation due to anterior white commissure damage (ALS)
2. Uni or bilateral paralysis of UEs due to anterior horn damage at cervical level or LEs at lumbar levels. ANterior horn damages spinal motor neurons. CST. This is a LMN deficit, so IL if unilateral.

Question 10

What characterizes an incomplete sc injury

Answer 10

Preservation of sacral cord fx at presentation.

Question 11

what characterizes complete sc injury

Answer 11

Bilateral and complete loss of motor and sensory fx below lesion for 24+ hours.