SYNDROMES OF SPINAL CORD

lesionsProf. Nabil Khalil

Suez canal university

• It is divided into complete and incomplete cord syndromes.

• INCOMPLETE CORD SYNDROMES.

• Brown sequards syndrome.

• Central cord syndrome.

• Anterior cord syndrome.

• Posterior cord syndrome.

• Conus medullaris syndrome.

• Cauda equina syndrome.

COMPLETE CORD TRANSECTION

Complete transaction 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 is very valuable.• 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

hyperreflexicparaplegia.• 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 SEQUARDS SYNDROME

BROWN SEQUARDS SYNDROME

• Due to damage to one lateral half of spinal cord.

• SENSORY• Ipsilateral loss of proprioception due to post

column involvement.• Contralateral loss of pain and temperature due

to .involvement of lateral spinothalamic tract.• MOTOR-Ipsilateral spastic weakness due to

descending corticospinal tract involvement• LMNsigns at the level of lesion.• Caused by extramedullary lesions• Usually caused by penetrating trauma or

tumour.

CENTRAL CORD SYNDROME

CENTRAL CORD SYNDROME

CENTRAL CORD SYNDROME• Most common cause is 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 >lowerlimb

• 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• 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 lhermittes sign.

POSTERIOR COLUMN SYNDROME

• Abadie’s sign positive.• Urinary incontinence.• Absent knee and ankle jerk.(areflexia,hypotonia)• Abdominal and laryngeal crisis can occur.• Charcots joint.• miotic and irregular pupil not reacting to light.• Argyl robertson pupil

POSTERO LATERAL COLUMN DISEASE

– CAUSES;

• VITB12 DEFICIENCY • AIDS • HTLV ASSOCIATED MYELOPATHY.• CERVICAL SPONDYLOSIS• Paresthesia in feet• Loss of proprioception and vibration in legs• Sensory ataxia

• positive rhomberg sign• Bladder atony• Corticospinal tract

involvement;spasticity,hyperreflexia ,bilateral Babinski sign.

• Aids:associated dementia and spastic bladder is present

• HTLV associated myelopathy;slowly progressive paraparesis increase in csf igG with antibodies to HTLV1.

ANTERIOR HORN CELL SYNDROMES

• CAUSED BY SPINAL MUSCULAR ATROPHY.

• MOTOR

• weakness ,atrophy and fasciculations.

• Hypotonia,depressed reflexes.

• Muscles of trunk and extremities are affected.

• Sensory system is not affected.

Ant horn cell and pyramidal tract syndrome

• Occurs in amytrophic lateral sclerosis.• Affects the ant horn cells and corticospinal

tract.• Both lmn and umn sign occur.• MOTOR• Ant horn cell-paresis ,atrophy,and

fasciculations.• Corticospinal tract –paresis ,spasticity and

extensor plantar response.•

• its usually unilateral with muscle weakness

• Reflexes are often exaggerated.

• Bulbar and pseudo bulbar involvement occurs.

• Sensory system is not affected.

• Superficial reflex-abdominal reflex is preserved

SPINAL ARTERY

ANTERIOR SPINAL ARTERY SYNDROME.

VASCULAR SYNDROMES OF SPINAL CORD

• Mostly occurs due to anterior spinal artery.

• 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.• Spinal cord infarction usually occurs in

T1 to T4 segment.and L1 • Occurs due to syphilitic arteritis ,aortic

dissection,atherosclerosis of aorta,SLE ,AIDS,AV malformation

• POST SPINAL ARTERY SYNDROME

• UNCOMMON

• Loss of proprioception and vibratory sense.

• Pain and temperature is preserved.

• Absence of motor deficit.

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

CAUDA EQUINA SYNDROME.

•

Begins at L2 disk space distal to conusBegins at L2 disk space distal to conus medullaris.medullaris. MOTORMOTORFlaccid lower extremities. Flaccid lower extremities. Knee and ankle jerk absent.Knee and ankle jerk absent.SENSORYSENSORY-Asymmetrical sensory loss-Asymmetrical sensory lossSaddle anaesthesiaSaddle anaesthesiaLoss of sensation around Loss of sensation around perineum,anus,genitals.perineum,anus,genitals.AUTONOMICAUTONOMIC-Loss of bladder and bowel -Loss of bladder and bowel function.function.Urinary retention.Urinary retention.Occurs due to acute disk herniation epidural Occurs due to acute disk herniation epidural haematoma,tumourhaematoma,tumour

ANTERIOR CORD SYNDROME

ANTERIOR CORD SYNDROME

ANTERIOR CORD SYNDROME

• Usually caused by hyperflexion injuries.

• Paralysis below the level of lesion.

• Pain and temperature loss.

• Dorsal column is preserved.

• Prognosis is poor.

• Area supplied by anterior spinal artery is affected.

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