Lesions of spinal cord

By Prithijit Kr Saha & Soumya Guchait

Final Year
 Syringomyelia
● Also known as spinal cord syndrome.
● Formation of cavities around the Central
canal usually in the lower cervical region.
● Bilateral loss of pain and temperature
occurs due to injury to decussating fibres
of lateral spinothalamic tract.
● Bilateral loss of touch occurs due to injury
to anterior spinothalamic tract.
● The decussation of lateral and anterior spinothalamic tracts occurs at
different levels so there is dissociated sensory loss.
● As this disease occurs in lower cervical and upper thoracic regions, there is
problem in both the upper limbs and front of chest.
 Brown Sequard Syndrome
● Caused due to hemisection of the spinal cord.
● Below the level of lesion :
1. Ipsilateral upper motor neuron
paralysis caused by pyramidal tract
damage.
2. Ipsilateral loss of conscious
proprioceptive sensations caused due
to damage to posterior white column.
3. Contralateral loss of pain and
temperature and touch caused due to
damage to lateral spinothalamic and
anterior spinothalamic tracts.
● At the level of lesion:
1. Ipsilateral lower motor neuron paralysis
caused due to damage to central nerve
roots.
2. Ipsilateral anaesthesia over the skin of
the segment due to injury to ventral
nerve roots.
● Above the level of lesion:
i. Ipsilateral hyperaesthesia due to
irritation of dorsal nerve roots.
 Anterior Spinal Artery Syndrome
● Also known as Anterior Cord Syndrome.
● Etiopathology:
Accidental vertebral fracture or dislocation
↓
Injury to Anterior spinal artery
↓
Resulting in cord contusion
↓
Ultimately leads to ischemia of anterior part of spinal cord
● Clinical features
1. Due to damage in anterior grey column: Bilateral lower motor neuron paralysis
and muscle atrophy at the level of lesion.
2. Due to damage in anterior corticospinal tracts: Bilateral spastic paralysis below
the level of lesion.
3. Due to damage antero-lateral spinothalamic tracts: Bilateral loss of pain,
temperat, and light touch sensations below the level of lesion.
 Tabes dorsalis
● Caused by syphilis.
● Etiopathogenesis: Organism causes selective destruction of nerve fibre at
the point of entrance of posterior root into spinal cord. (Mostly at the level of
lower thoracic and lumbar-sacral region)
● Clinical features : As the dorsal root is affected so mostly the sensory parts will be affected
and the motor part will be preserved.

● Exaggeration of sensations:-
a. Stabbing pain in lower limb.
b. Hypersensitivity of skin to touch, heat, cold

● Loss of sensations:-
a. Paraesthesia.
b. Loss of deep pain sensation.
c. Ataxia of lower limb.
d. Loss of tendon reflex.
 Guillain-Barré syndrome
● Named after famous neurologists Georges Guillain and Jean Alexander
Barré.
● Etiology: Campylobacter jejuni
● Pathogenesis : Type IV HS reaction.
Prior Campylobacter infection
↓ (In recovery phase)
Ab formed against Campylobacter inside the body, cross react with myelin component of spinal cord
(Type IV Hypersensitive Reaction)
↓
Resulting in Demyelination of spinal cord and Peripheral nerves in ascending order
(Ascending paralysis)

● Clinical presentation:
a. Flaccid paraplegia
b. Truncal paralysis
c. Quadriplegia
d. Respiratory muscle paralysis (most common cause of death)