Spinal Cord Syndromes

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Basics

Description

  • Complete cord syndrome:
    • Total loss of sensory, autonomic, and voluntary motor innervation distal to the spinal cord level of injury
    • Usually caused by trauma, but other causes include infarction, hemorrhage, and extrinsic compression
    • Symptoms that remain >24 hr are generally permanent
  • Incomplete spinal cord lesions:
    • Characterized by preservation of some spinal cord function
    • 3 major types: Central cord syndrome, Brown-Séquard, and anterior cord syndrome
  • Central cord syndrome:
    • Most common of the incomplete spinal cord syndromes
    • Classically occurs in elderly patients, with pre-existing cervical stenosis, who suffer a hyperextension injury in a fall
  • Anterior cord syndrome:
    • Most commonly associated with occlusion of the anterior spinal artery which can occur after aortic surgery or trauma. Other causes include hypotension and infection
  • Brown-Séquard syndrome:
    • Hemisection of the spinal cord, classically as a result of a penetrating injury
    • Rarely unilateral cord compression
  • Conus medullaris syndrome:
    • Injury at the level of L1 or L2
    • Causes include central disc herniation, neoplasm, and direct trauma
  • Cauda equina syndrome:
    • Injury to the nerve roots of the cauda equine and not the spinal cord itself
    • Causes include central disc herniation and direct trauma
    • Clinically, can resemble conus medullaris syndrome

Etiology

  • Spinal cord syndromes result from localized disruption of neurotransmission and exhibit mixed motor and sensory deficits. The most common mechanism is trauma
  • Patients with arthritis, osteoporosis, metastatic disease, or other chronic spinal disorders are at risk of developing spinal injuries as the result of minor trauma

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Basics

Description

  • Complete cord syndrome:
    • Total loss of sensory, autonomic, and voluntary motor innervation distal to the spinal cord level of injury
    • Usually caused by trauma, but other causes include infarction, hemorrhage, and extrinsic compression
    • Symptoms that remain >24 hr are generally permanent
  • Incomplete spinal cord lesions:
    • Characterized by preservation of some spinal cord function
    • 3 major types: Central cord syndrome, Brown-Séquard, and anterior cord syndrome
  • Central cord syndrome:
    • Most common of the incomplete spinal cord syndromes
    • Classically occurs in elderly patients, with pre-existing cervical stenosis, who suffer a hyperextension injury in a fall
  • Anterior cord syndrome:
    • Most commonly associated with occlusion of the anterior spinal artery which can occur after aortic surgery or trauma. Other causes include hypotension and infection
  • Brown-Séquard syndrome:
    • Hemisection of the spinal cord, classically as a result of a penetrating injury
    • Rarely unilateral cord compression
  • Conus medullaris syndrome:
    • Injury at the level of L1 or L2
    • Causes include central disc herniation, neoplasm, and direct trauma
  • Cauda equina syndrome:
    • Injury to the nerve roots of the cauda equine and not the spinal cord itself
    • Causes include central disc herniation and direct trauma
    • Clinically, can resemble conus medullaris syndrome

Etiology

  • Spinal cord syndromes result from localized disruption of neurotransmission and exhibit mixed motor and sensory deficits. The most common mechanism is trauma
  • Patients with arthritis, osteoporosis, metastatic disease, or other chronic spinal disorders are at risk of developing spinal injuries as the result of minor trauma

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