Spinal Cord Injury
SPINAL CORD INJURY
2 types –
- Complete cord injury.
- Incomplete cord injury.
I. INCOMPLETE CORD INJURY:
- Some motor & sensory fucntions preserved below injury level.
Syndromes included –
- Central cord syndorme.
- Brown-Sequard syndrome.
- Anterior cord syndrome.
- Posterior cord syndrome.
1a. CENTRAL CORD SYNDROME:
Clinical presentation –
- Bilateral sensory & motor deficits.
- Dissociative motor weakness –
- Ie., Upper extremity weakness > lower extremity.
- Hyper-reflexia in lower extremity.
- Sacral sparing.
2. BROWN-SEQUARD SYNDROME:
- Caused by spinal cord hemisection.
- I.e. Damaged left/right half of spinal cord.
- Most clinical presentation – Occur below level of lesion.
2a. Ipsilateral sensory loss –
- Due to ipsilateral dorsal column involvement affecting,
- Fine touch.
- Proprioception (joint & body position sense).
- Vibration.
2b. Ipsilateral motor deficit –
- Due to ipsilateral corticospinal tract (Pyramidal tract) involvement.
- Causes UMN paralysis.
2c. Contralateral sensory loss –
- Due to contralateral spinothalamic tract involvement.
- Affects pain & temperature.
2d. Unilateral segmental sign –
- Muscular atrophy, radicular of pain & decreased tendon reflex.
3. ANTERIOR CORD SYNDROME:
Cause:
- Vascular ischemia.
- Compression of anterior spinal artery & anterior spinal cord.
Clinical presentation:
- Neural function is absent in anterior 2/3rd of spinal cord.
- Complete motor function loss.
- Loss of pain & temperature sensation below level of injury.
- Intact vibration, proprioception & fine touch.
- Due to spared posterior (dorsal) column.
4. POSTERIOR CORD SYNDROME:
- Bilateral loss of fine touch, proprioception & vibration, below level of lesion.
- Due to bilateral dorsal column involvement.
- Intact motor function, pain & temperature sensations.
- Due to anterior 2/3rd cord sparing containing corticospinal & spinothalamic tract.
II. COMPLETE SPINAL CORD INJURY:
Clinical presentation:
Below level of injury –
- Absence of sensory & motor function.
- Usually after spinal shock recovery).
- Flaccid paralysis.
- Areflexia.
- Anesthesia.
- Neurogenic shock (hypotension & bradycardia) –
In Upper thoracic (above T6) & cervical cord injury.
Exam Question
SPINAL CORD INJURY
- Central cord syndrome – Sacral sparing.
Brown – Sequard syndrome –
Ipsilateral sensory loss –
- Fine touch, Proprioception (Joint position & body position sense) & Vibration.
- Due to ipsilateral dorsal column involvement.
Ipsilateral motor deficit –
- Due to ipsilateral corticospinal tract (Pyramidal tract) involvement.
- Upper motor neuron paralysis.
Contralateral sensory loss –
- Pain & temperature.
- Due to contralateral spinothalamic tract involvement.
Unilateral segmental sign.
3. Anterior cord syndrome –
- Caused by compression of anterior spinal artery.
- Complete motor function loss, pain & temperature sensation below level of injury.
- Preservation of vibration, proprioception & fine touch.
- Due to spared posterior (dorsal) column.
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