Question 5

Syndrome

Aetiology

Clinical Findings

Complete 
Transection

Trauma, Infarction, Transverse
Myelitis, Abscess, Tumour

Complete loss of motor and sensory function below level of the lesion

Cord Hemisection

Trauma, Multiple Sclerosis,
Tumour, Abscess

Ipsilateral loss of motor and
proprioception. Contralateral pain and temperature loss

Central Cord

Neck hyperextension,
syringomyelia, tumour

Motor impairment greater in upper limbs than lower
Variable sensory loss, bladder dysfunction

Anterior Cord

Hyperflexion, disc protusion, anterior spinal artery occlusion, Post AAA

Motor function impairment,

Pain and temperature loss, proprioception spared.

Cauda Equina

Disc protusion, tumour, infective

Bladder/bowel dysfunction Altered sensation in saddle area, sexual dysfunction.

Syndrome

Characteristic features

Causes

There are some causes which are generic for all these syndromes, and they will not be repeated in each box. These are:

Any of these can cause any of the spinal syndromes, anywhere. Instead of these, the causes listed below are the characteristic pathological processes which usually give rise to a specific spinal cord syndrome, eg. anterior spinal artery occlusion causing anterior spinal syndrome.

Cord transection

• Lost bilateral motor
• Flaccid areflexia
• Lost bilateral sensory

• Transverse Myelitis

Cord hemisection

• Lost ipsilateral motor
• Lost ipsilateral proprioception
• Lost ipsilateral light touch
• Lost contralateral pain and temperature

• Penetrating spinal injury
• Radiation inury
• Spinal metastases

Anterior cord injury

• Preserved bilateral proproception
• Lost bilateral pain, temperature, touch
• Lost bilateral motor control

Interruption of the blood supply to the anterior spinal cord:

• Aortic dissection
• IABP complication

Posterior cord injury

• Lost proprioception
• Other sensation preserved bilaterally
• Preserved power bilaterally
• Ataxia results

• Hyperextension injury
• Posterior spinal artery injury
• Tertiary syphilis
• Friedrich's ataxia
• Subacute degeneration (Vitamin B12 deficiency)
• Atlantoaxial subluxation

Central cord syndrome

• Sacral sensation preserved
• Greater weakness in the upper limbs than in the lower limbs.

• Hyperextension injury with pre-existing canal stenosis
• Ependymoma
• Syringomyelia

Conus medullaris syndrome

• symmetrical paraplegia
• Mixed upper and lower motor neuron
  findings

• The same sort of pathologies can give rise either to a cauda equina syndrome or a conus medullaris syndrome; the difference is the level.

Cauda Equina syndrome

• asymmetrical, lower motor neuron lower limb weakness
• saddle area paraesthesia
• bladder and bowel areflexia