SYNDROMES OF

SPINAL CORD
DR.A.MEENAKSHI

PROF.S.TITO’S UNIT
M6
• 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.
 POSTERIOR COLUMN
SYNDROME
• 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.
• 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 conus
medullaris.
• 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.
Occurs due to acute disk herniation epidural
haematoma,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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