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 2/3^rd 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 2/3^rd 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 Important

SPINAL CORD INJURY

1. Central cord syndrome – Sacral sparing.

2. 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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SPINAL CORD INJURY