Question 4

With respect to pathological conditions of the spinal cord, list two causes of, and the clinical findings for each of the following syndromes:

a) Complete cord transection.

b) Cord hemisection.

c) Central cord syndrome.
c) Anterior cord syndrome (anterior spinal artery syndrome). 

d) Cauda Equina syndrome.

You may tabulate your answer.

[Click here to toggle visibility of the answers]

College answer

Not available.

Discussion

This question is identical to Question 5 from the first paper of 2010 and Question 15 from the first paper of 2015.

Causes and Characteristic Features of Spinal Cord Syndromes

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:

  • Trauma
  • Infarction
  • Abscess
  • Tumour or metastatic compression
  • Haematoma
  • AVM/haemorrhage

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

References

Oh's Manual: Chapter 78 (pp. 795) Spinal injuries by Sumesh Arora and Oliver J Flower

Wagner, Robert, and Andy Jagoda. "Spinal cord syndromes." Emergency medicine clinics of North America 15.3 (1997): 699-711.

Lin, Vernon W., et al. "Spinal Cord and Cauda Equina Syndromes." (2003).

Maynard, Frederick M., et al. "International standards for neurological and functional classification of spinal cord injury." Spinal cord 35.5 (1997): 266-274.

Hayes, Keith C., et al. "Classifying incomplete spinal cord injury syndromes: algorithms based on the International Standards for Neurological and Functional Classification of Spinal Cord Injury Patients." Archives of physical medicine and rehabilitation 81.5 (2000): 644-652.

McDonald, John W., and Cristina Sadowsky. "Spinal-cord injury." The Lancet 359.9304 (2002): 417-425.

Djurberg, H., and M. Haddad. "Anterior spinal artery syndrome." Anaesthesia 50.4 (1995): 345-348.

Eltorai, Ibrahim M. "Anterior Spinal Artery Syndrome." Rare Diseases and Syndromes of the Spinal Cord. Springer, Cham, 2016. 437-440.

Foo, Dominic, and Alain B. Rossier. "Anterior spinal artery syndrome and its natural history." Spinal Cord 21.1 (1983): 1.

Zuber, William F., Max R. Gaspar, and Philip D. Rothschild. "The anterior spinal artery syndrome--a complication of abdominal aortic surgery: report of five cases and review of the literature.Annals of surgery 172.5 (1970): 909.

TRIGGS, WILLIAM J., and ALEKSANDAR BERIĆ. "Sensory abnormalities and dysaesthesias in the anterior spinal artery syndrome." Brain 115.1 (1992): 189-198.

Aydin, A. "Mechanisms and prevention of anterior spinal artery syndrome following abdominal aortic surgery." Angiologiia i sosudistaia khirurgiia= Angiology and vascular surgery 21.1 (2015): 155-164.

Santamato, Andrea, et al. "Paraplegia due to Anterior Spinal Artery Stroke: Rehabilitative Program on Lower Extremity Weakness and Locomotor Function." Int J Phys Med Rehabil1.118 (2013): 2.

Ullery, Brant W., et al. "Risk factors, outcomes, and clinical manifestations of spinal cord ischemia following thoracic endovascular aortic repair." Journal of vascular surgery 54.3 (2011): 677-684.

Cheshire, William P., et al. "Spinal cord infarction Etiology and outcome." Neurology 47.2 (1996): 321-330.

Gialdini, Gino, et al. "Retrospective analysis of Spinal Cord Infarction after Aortic Repair (P6. 300)." Neurology 88.16 Supplement (2017): P6-300.

Hnath, Jeffrey C., et al. "Strategies to improve spinal cord ischemia in endovascular thoracic aortic repair: outcomes of a prospective cerebrospinal fluid drainage protocol." Journal of vascular surgery 48.4 (2008): 836-840.

Chiesa, Roberto, et al. "Spinal cord ischemia after elective stent-graft repair of the thoracic aorta." Journal of vascular surgery 42.1 (2005): 11-17.

Coselli, Joseph S., et al. "Left heart bypass during descending thoracic aortic aneurysm repair does not reduce the incidence of paraplegia." The Annals of thoracic surgery 77.4 (2004): 1298-1303.

Safi, Hazim J., et al. "Thoracic and thoracoabdominal aortic aneurysm repair using cardiopulmonary bypass, profound hypothermia, and circulatory arrest via left side of the chest incision." Journal of vascular surgery 28.4 (1998): 591-598.

Cambria, Richard P., et al. "Clinical experience with epidural cooling for spinal cord protection during thoracic and thoracoabdominal aneurysm repair." Journal of vascular surgery 25.2 (1997): 234-243.

Cinà, Claudio S., et al. "Cerebrospinal fluid drainage to prevent paraplegia during thoracic and thoracoabdominal aortic aneurysm surgery: a systematic review and meta-analysis." Journal of vascular surgery 40.1 (2004): 36-44.

Taira, Yutaka, and Martin Marsala. "Effect of proximal arterial perfusion pressure on function, spinal cord blood flow, and histopathologic changes after increasing intervals of aortic occlusion in the rat." Stroke 27.10 (1996): 1850-1858.

Strohm, Tamara, Seby John, and Muhammad Hussain. "Cerebrospinal Fluid Drainage for Acute Spinal Cord Infarction (P1. 301)." Neurology 88.16 Supplement (2017): P1-301.