Neurology · MU Sofia

32. Spinal cord syndromes

Covers the ascending and descending tracts of the spinal cord and the usual causes of cord lesions, then goes through complete transection, Brown-Séquard, anterior, posterior and central cord syndromes, and syringomyelia. It ends with conus medullaris and cauda equina syndromes. A mnemonic for Brown-Séquard findings, a summary of which tracts each syndrome affects, and clinical features for each syndrome are included.

Inside: 2 sections · 3 labelled pictures · 15 flashcards · 3 min

Topic 32 of 88 in the MU Sofia syllabus for Neurology (Medicine, Year 4). The free AceMed note covers it in 2 sections, about 399 words (3 min of reading), with 15 flashcards.

In this note

  1. Spinal cord syndromes
  2. Central Cord Syndrome the most common form of incomplete spinal cord injury

Spinal cord syndromes

Anatomy & Functions of the Spinal Cord

The spinal cord contains:

Ascending sensory tracts

  • Posterior columns → vibration, proprioception, fine touch
  • Spinothalamic tract → pain and temperature

Descending motor tracts

  • Corticospinal tract → voluntary movement
  • Anterior horn cells → LMN function

Spinal cord lesions typically cause:

  • Bilateral symptoms below the lesion
  • Sensory level
  • Motor deficits
  • Bladder and bowel dysfunction

Etiology:

  1. 1.Trauma
  2. 2.Neoplasms: Primary spinal tumors or metastatic lesions compressing the cord.
  3. 3.Vascular Infarction: Occlusion of the anterior spinal artery leads to anterior cord syndrome.
  4. 4.Compression/Degenerative Disease: Spondylosis, spinal stenosis, disc herniation, epidural hematomas, or abscesses.
  5. 5.Inflammatory/Demyelinating: Conditions like multiple sclerosis or transverse myelitis.
  6. 6.Intrinsic Lesions: Syringomyelia (fluid-filled cavities) causing central cord syndromes

Complete Spinal Cord Transection

  • Features Below the Lesion: Bilateral paralysis. Loss of all sensations. Loss of reflexes initially (spinal shock). Later spasticity and hyperreflexia. Bladder and bowel dysfunction

Brown-Séquard Syndrome (Hemisection) a rare neurological disorder caused by damage to exactly one half (a hemisection) of the spinal cord

Causes: Trauma. Tumors. Multiple sclerosis

Findings

  • Ipsilateral: Spastic paralysis (corticospinal tract). Loss of vibration and proprioception (posterior columns)
  • Contralateral: Loss of pain and temperature (spinothalamic tract)

Mnemonic "Same Motor, Opposite Pain"

Anterior Cord Syndrome an incomplete spinal cord injury characterized by motor paralysis and loss of pain and temperature sensation below the injury site, while touch, vibration, and proprioception remain intact

Structures Affected: Corticospinal tracts. Spinothalamic tracts

Features: Bilateral paralysis. Loss of pain and temperature. Preservation of vibration and proprioception

Causes: Anterior spinal artery infarction

Posterior Cord Syndrome a rare, incomplete spinal cord injury characterized by damage to the dorsal (posterior) columns of the spinal cord.

Features: Loss of vibration sense. Loss of proprioception. Sensory ataxia. Positive Romberg sign

Causes: Vitamin B12 deficiency. Tabes dorsalis

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