Incomplete Cord Syndromes

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See kunam et al for an open access review.[1]

There are six patterns of deficit in the spinal cord:

Features

Summary of Incomplete Spinal Cord Syndrome Features[1]
Type Tracts Involved Lesion Location Common Causes Clinical Features
Central - small lesion Anterior commissure where STT fibres cross Near the central canal Syringomyelia, intra-medullary tumour, hyperextension injury in cervical spondylosis Suspected sensory deficit, classic cape distribution in lesion of cervical cord
Central - large lesion Bilateral STT, CST, dorsal columns (variable), autonomic centre, and anterior horn cells Large central lesion Syringomyelia, intra-medullary tumour, hyperextension injury in cervical spondylosis Disproportionate motor (UMN type) and sensory deficits: greater in upper extremities than in lower extremities, LMN deficit at level of lesion (anterior horn cells), variable loss of proprioception, autonomic dysfunction
Ventral cord Bilateral STT, CST, and autonomic center Ventral two thirds of cord Spinal cord infarction, trauma, multiple sclerosis, disk herniation Loss of pain and temperature sensations, weakness, bladder dysfunction
Dorsal cord l Predominately dorsal columns; large lesions involve bilateral CST and bilateral autonomic fibers (to variable degree) Dorsal one-third of cord Vitamin B12 deficiency, multiple sclerosis, tabes dorsalis, AIDS* myelopathy, epidural metastases Loss of proprioception and vibration sensations, sensory ataxia with positive Romberg sign, variable weakness, bladder dysfunction
Brown-Sequard Unilateral STT, CST, and dorsal columns Hemicord lesion Knife or bullet injury, multiple sclerosis, transdural migration of spinal cord Ipsilateral weakness (UMN type) and loss of proprioception, contralateral loss of pain and temperature sensations, small band of LMN and sensory deficits at level of lesion
Conus medullaris Distal spinal cord containing lumbosacral segment Spinal cord at level of T12 through L2 vertebrae Disk herniation, trauma, tumors Bladder or rectal dysfunction, saddle anesthesia, paraparesis (mixed UMN and LMN types)
Cauda equina Lumbosacral nerve roots in spinal canal Lesion compressing or involving nerve roots of cauda equina Disk herniation, arachnoiditis, tumor, lumbar spine stenosis Asymmetric multiradicular pain, leg weakness (purely LMN) and sensory loss, bladder dysfunction, areflexia

Gallery

See Also

References

  1. 1.0 1.1 Kunam et al.. Incomplete Cord Syndromes: Clinical and Imaging Review. Radiographics : a review publication of the Radiological Society of North America, Inc 2018. 38:1201-1222. PMID: 29995620. DOI.

Literature Review