Lesions of the Spinal cord - Spinal Cord Syndromes



Spinal cord lesions can result in permanent neurologic disability. It is important to quickly evaluate and treat spinal cord injury. Causes of spinal cord lesions can be divided into:

 • Extrinsic Causes:

	- Spinal stenosis

	- Abscess

	- Tumor

	- Herniated disc

	- Hematoma

	- Stab wound and other forms of trauma

 • Intrinsic Causes:

	- Infarction

	- Infection (e.g., poliovirus, syphilis, and HIV)

	- Vitamin B12, Copper deficiency

	- Syrinx

	- Tumor of the spinal cord

	- Autoimmune



The clinical presentation of spinal cord lesions depends on which ascending or descending fibers are involved.



Brown-Séquard Syndrome:

 • Etiology:

	- Knife or bullet injury

	- Multiple sclerosis

 • Clinical Presentation:

	- Ipsilateral findings:

		- Weakness

		- Lower motor neuron symptoms at the level of the lesion

		- Upper motor neuron symptoms below the level of the lesion

		- Loss of proprioception, vibration, light touch, and tactile sense

	- Contralateral findings:

		- Loss of pain and temperature sensation usually 1 to 2 levels below the level of the lesion



Posterior Cord Syndrome:

 • Etiology:

	- Tabes dorsalis

	- Friedreich ataxia

	- Subacute combined degeneration

	- Multiple sclerosis

 • Clinical Presentation:

	- Loss of proprioception and vibration sense

	- Variable weakness

	- Bladder dysfunction



Central Cord Syndrome:

 • Etiology:

	- Syringomyelia

	- Intramedullary tumor

	- Hyperextension injury in patients with a long history of cervical spondylosis

 • Clinical Presentation:

	- Loss of pain and temperature in the distribution of the level of spinal cord injury

	- If the spinal cord lesion expands, it may result in:

		- Weakness at the level of sensory loss (the corticospinal tract and/or the anterior horn gray matter is involved)

		- Tendon reflex loss (neuronal fibers involved in deep tendon reflexes are involved)



Anterior (Ventral) Cord Syndrome:

 • Etiology - Anterior spinal artery infarction which can be caused by:

	- Compression injury

	- Vertebral burst fracture

	- Intervertebral disk herniation

	- Radiation myelopathy

 • Clinical Presentation:

	- Typically involves tracts in the anterior two-thirds of the spinal cord which result in:

		- Muscle weakness:

			- The corticospinal tracts are involved

		- Bilateral loss of pain and temperature sensation:

			- The spinothalamic tracts are involved

		- Urinary incontinence:

			- The descending autonomic tracts are involved & the posterior columns are spared



Conus Medullaris:

 • Etiology:

	- Disc herniation

	- Trauma

	- Malignancy

 • Clinical Presentation:

	- Sphincter dysfunction

	- Flaccid paralysis of the bladder and rectum

	- Impotence

	- Saddle anesthesia (more commonly bilateral)

	- S3-S5 involvement



Cauda Equina Syndrome:

 • Etiology:

	- Disc herniation

	- Lumbar spinal stenosis

	- Malignancy

 • Clinical Presentation:

	- Asymmetric multiradicular pain

	- Leg weakness

	- Bladder and rectal sphincter paralysis

	- Sensory loss

	- Saddle anesthesia (more commonly unilateral)



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