Question 4

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