SPINAL CORD ANATOMY AND

SPINAL CORD SYNDROMES

DR. SACHIN ADUKIA

SYNDROMES OF SPINAL CORD

It is divided into complete and incomplete cord syndromes.

INCOMPLETE CORD SYNDROMES. Brown Sequard syndrome. Central cord syndrome. Anterior cord syndrome. Posterior cord syndrome. Conus medullaris syndrome. Cauda equina syndrome.

COMPLETE CORD TRANSECTION

Complete transection of spinal cord

Causes Trauma Metastatic carcinoma Multiple sclerosis Spinal epidural haematoma Autoimmune disorders Post vaccinial syndromes.

All ascending tracts from below and descending tracts from above are interrupted.

Affects motor sensory and autonomic functions.

SENSORY all sensations are affected. Pin prick test. Sensory level is usually 2 segments below the level of

lesion. Segmental paresthesia occur at the level of lesion.

Motor-paraplegia due to corticospinal tract. First spinal shock-followed by hypertonic hyperreflexic

paraplegia. Loss of abdominal and cremastric reflexes. At the level of lesion LMN signs occur.

Autonomic- Urinary retention and constipation. Anhidrosis ,trophic skin changes, vasomotor instability

below the level of lesion. Sexual dysfunction can occur.

Brown Sequard Syndrome

Central cord syndrome

CENTRAL CORD SYNDROME

MC: syringomyelia.others : hyperextension injuries of neck,

intramedullary tumours,trauma.Associated with Chiari Type 1 and 2 and Dandy

Walker malformation.SENSORY

Pain and temperature are affected. Touch and proprioception are preserved. Dissociative anaesthesia. Shawl like distribution of sensory loss.

MOTOR. Upper limb weakness >lower limb

Other features: Horners syndrome Kyphoscoliosis Sacral sparing Neuropathic arthropathy of shoulder and elbow joint Prognosis is fair.

Occurs due to neurosyphilis, diabetes mellitus

Usually occurs 10 to 20 yrs after infection

POSTERIOR COLUMN SYNDROME

SENSORY Impaired position and vibration sense in LL Tactile and postural hallucinations can occur. Numbness or paresthesia are frequent

complaints.. Sensory ataxia. Positive Rhomberg sign. Positive Sink sign Positive Lhermitte.s sign.

Abadie’s sign positive.Urinary incontinence.Absent knee and ankle jerk.(areflexia, hypotonia)Abdominal and laryngeal crisis can occur.Charcot’s joint.

ANTERIOR CORD SYNDROME.

ANTERIOR CORD SYNDROME

Conus medullaris is frequently involved.

Lies opposite to vertebral bodies T12 and L1.

Neck pain of sudden onset.

MOTOR

Flaccid and areflexic paraplegia

SENSORY

Loss of pain and temperature.

Preservation of positon and vibration.

AUTONOMIC

urinary incontinence

Occurs due to syphilitic arteritis ,aortic dissection, atherosclerosis of

aorta, SLE, AIDS,AV malformation

CONUS MEDULLARIS SYNDROME

Contributes to 25%spinal cord injuries.Lies opposite to vertebral bodies of T12 and

L1.Caused by flexion distraction injuries and

burst fractures.Both UMN and LMN deficits occur.Development of neurogenic bladder.

CAUDA EQUINA SYNDROME.

•Begins at L2 disc space distal to conus medullaris.

•Occurs due to acute disc herniation epidural haematoma, tumour

•MOTOR

• Flaccid lower extremities.

• Knee and ankle jerk absent.

•SENSORY-Asymmetrical sensory loss

• Saddle anaesthesia

• Loss of sensation around perineum, anus, genitals.

•AUTONOMIC-

• Loss of bladder and bowel function.

• Urinary retention.

References

Haines DE. Lippincott's Illustrated Q&A Review of Neuroscience. Lippincott Williams & Wilkins; 2010 Oct 27.

Daroff RB, Jankovic J, Mazziotta JC, Pomeroy SL. Bradley's neurology in clinical practice. Elsevier Health Sciences; 2015 Oct 25.

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