SPINAL CORD INJURY

A i.e. Ipsilateral loss of joint sensation

B i.e. Vibration and Proprioception

In anterior spinal artery syndrome all spinal cord function (motor, sensory and autonomic) are lost below the level of lesion with the striking exception of retained vibration and position senseQ.[As posterior column is supplied by posterior spinal artery]

Ans.A  i.e. Central cord syndrome

Central cord syndrome is defined by the American spinal injury association (ASIA) as a clinical presentation, characterized by “dissociation” in the degree of motor weakness with lower limbs stronger than upper limbs and sacral sparing present.

Complete lesion (transection)

No motor or sensory function in the lowest sacral segments (S4-S5)/ below the level of spinal cord injury in the absence of spinal shock.

Patients may gain some root function about the level of injury – a phenomenon called root escape because this damage to nerve roots is a peripheral nerve injury (& maybe neuropraxia). And it should not be taken as the potential return of spinal cord function.

Incomplete lesion

Any evidence of neurological function (sensory or motor) distal to the level of injury.

Documentation of sacral nerve but function (perianal sensation, rectal tone and flexion of the great toe) may be the only sign of partially functioning spinal cord or incomplete lesion.

Central Cord Syndrome

It occurs due to damage of the spinal cord near the central canal area. The main causes are hyperextension trauma, Syringomyelia, tumor, and anterior spinal artery ischemia. It is the most frequent of incomplete cord syndromes and occurs most frequently in elderly people with underlying degenerative spondylosis.

Dissociative motor weakness with arm weakness out of proportion to leg weakness.

Sacral sensory sparing

– ‘Dissociated sensory loss’ signifying a loss of pain and temperature sense (lateral spinothalamic tract) in a cape distribution over the shoulders, lower neck, and upper trunk in contrast to intact light touch, joint position, and vibration sense (posterior column) in these regions.

– 50- 75% show some neurological improvement in the following order- a return of lower extremity strength, return of bladder function, return of upper extremity strength, and return of intrinsic function of the hand.

Anterior Cord Syndrome

Both spinoth­almic & corti­cospinal tracts (located in the anterior aspe­ct of the spinal cord) are injured with preservation of dorsal columns

– Variable loss of pain and temperature sensation and motor functions with preservation of proprioception, vibratory sense, and deep pressure sensation.

Brown Sequard Syndrome

It is functional hemisection of the spinal cord leading to motor weakness on the ipsilateral side of lesion & sensory deficit on the contralateral side (in broad terms).

It consists of an ipsilateral motor (corticospinal tract) and proprioception (posterior column) loss and contralateral pain & temperature (spinothalamic tract) sensory loss.

Segmental signs, such as radicular pain, muscle atrophy, or loss of deep tendon reflex, are unilateral.

Posterior Cord Syndrome

– Posteriorly located dorsal column is injured with intact spinothalamic and corticospinal tracts.

– Loss of position and vibratory sense below the level of injury.

Answer is C (Proprioception):

Proprioception is lost on the same side of lesion in Brown Sequard Syndrome.

Brown sequard syndrome or hemisection of the cord is associated with loss of posterior column sensations (vibration joint position sense, proprioception, fine touch) on the same side of lesion.

Sensations transmitted by the anterolateral column or spinothalamic tract (pain, touch, temperature) are lost on the opposite side of lesion

Sensations lost on the same side as the lesion

Sensations transmitted by the posterior column are lost on the same side

Brown Sequard Syndrome (Hemisection of the cord)

Ipsilateral posterior column involvement

• Vibration
• Joint position (proprioception)Q
• Fine touch

Motor power is lost on the same side as that of the lesion (Ipsilateral corticospinal tract involvement)

Sensation lost on the opposite side of lesion

Sensations transmitted by the anterolateral spinothalamic tracts are lost on the opposite side Contralateral spinothalamic tract involvement

• Touch (Crude touch)
• Pain
• Temperature

Answer is C (Contralateral Posterior Column Features):

Brown-Sequard Syndrome (Hemisection of spinal cord) is characterized by lesions of the ipsilateral posterior column (and not contralateral posterior column).

 The_pvramidal tract (corticospinal tract) is involved on the same side (ipsilateral pyramidal tract features), which also explains the ipsilateral planter extensor response. The spinothalamic tract is involved on the contralateral side since fibres of the spinothalamic tract ascends in the spinal cord after having crossed at their respective spinal levels.

Answer is D (Contralateral posterior column involvement):

Brown – Sequard syndrome or hemisection of the spinal cord leads to loss of joint position and vibratory sense (posterior coluntn movement) on the ipsilateral side and not on the contralateral side. – Harrison 16^th / 2441, 144

Brown sequard syndrome: Hemisection of spinal cord

• Ipsilateral involvement of corticospinal tract : ipsilateral loss of motor power.
• Ipsilateral involvement of posterior column : ipsilateral loss of joint position and vibratory sense.
• Contralateral involvement of spinothalamic tract : contralateral loss of joint position and vibratory sense.

Segmental signs such as radicular pain muscle atrophy or loss of deep tendon reflexes arc unilateral (Lower motor neuron signs at level of lesion).

Answer is B (Contralateral loss of pain):

Brown-Sequard Hemicord Syndrome is associated with contralateral loss of pain and temperature sense

• Ipsilateral Weakness (corticospinal tract)
• Ipsilateral Loss of joint position and vibratory sense (posterior column),
• Contralateral Pain and temperature sense (spinothalamic tract) one or two levels below the lesion
• Unilateral Segmental signs, such as radicular pain, muscle atrophy, or loss of a deep tendon reflex

Answer is A (Loss of sympathetic tone) :

Spinal cord il4tiry mat’ produce hjpotension due to loss ofsympathetic tone. – ATLS 7^th / 73

Interruption of sympathetic vasomotor input after a high cervical spinal cord injury may result in neurogenic shock. – Harrison

Shock associated with spinal cord injury

Answer is B (Loss of vibration sense):

Anterior spinal artery thrombosis does not involve the posterior column and hence vibration sense and joint positions sense (proprioception) are preserved.