Spinal cord syndromes

Clinical Presentation

Complete transection
- Loss of all sensory modalities with sensory level
- Flaccid paraplegia or tetraplegia with sphinct dysfunction
Central cord syndrome
- Weakness in arms > legs
  - LMN in arms, UMN in legs
- Sacral sparing
- Suspended (i.e. arms only) sensory loss, sparing vibration and proprioception
- Differential includes cervical spondylopic myelopathy, central spinal hematoma
- Confused with carpal tunnel syndrome
Brown-Sequard syndrome (hemisection)
- Loss on contralateral pain/temperature starting 2 segments below lesion
- Loss of ipsilateral proprioception and weakness
- Most commonly seen in multiple sclerosis
Anterior cord syndrome
- Loss of pain/temperature below lesion with preserved dorsal column function (proprioception and vibration)
- Flaccid areflexic paraparesis (anterior horn involvement)
- Typically from disc herniation in T- or C-spine
Cauda equina syndrome
- Saddle anaesthesia
- Flaccid paraparesis and loss of sphincter control
Subacute combined degeneration of the cord
- Affects both dorsal column (long tract) and cotricospinal tract
- Bilateral limb weakness, numbness, and tingling that worsens progressively, with decreased vibration and proprioception
- Differential includes vitamin B12 deficiency