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Incomplete spinal cord syndromes

Last updated: June 4, 2021

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Incomplete spinal cord syndromes are caused by lesions of the ascending or descending spinal tracts that result from trauma, spinal compression, or occlusion of spinal arteries. Central cord syndrome, anterior cord syndrome, posterior cord syndrome, and Brown-Séquard syndrome are the most common types of incomplete spinal cord syndromes. In contrast to a complete spinal cord injury, lesions only affect part of the cord, and patients present with a dissociated sensory loss. A spine MRI is the diagnostic modality of choice to determine the etiology, level, and extent of the lesion. Treatment depends on the underlying etiology. In some cases, surgery may be necessary to treat the underlying cause and to improve the patient's outcome. Spinal compression is a medical emergency and requires urgent treatment with steroids and decompressive surgery.

Basic neuroanatomy and function

Overview of incomplete spinal cord syndromes

Types of incomplete spinal cord syndromes
Syndrome Affected spinal tracts Etiology [1][2] Clinical features*
Central cord syndrome (most common)
  • Bilateral paresis: upper > lower extremities
Anterior cord syndrome
Posterior cord syndrome
  • Bilateral loss of proprioception, vibration, and touch sensation below the level of the lesion [3]
Brown-Séquard syndrome (hemisection syndrome)
  • Hemisection of the cord

*All syndromes present with dissociated sensory loss: a pattern of selective sensory loss (“dissociation of modalities”), which suggests a focal lesion of a single tract within the spinal cord (or brainstem). [4]

Overview of incomplete spinal cord lesions

Spinal cord lesions
Pathophysiology Affected spinal tracts Clinical features
Syringomyelia
  • Symmetrical loss of:
    • Pain and temperature
    • Sensation
  • Bilateral, symmetrical dysesthetic pain
  • Affects neck, shoulders, and arms (cape-like distribution)
  • Other: Horner syndrome
Spinal muscular atrophy
  • Congenital motor neuron disease: autosomal recessive SMN1 mutation → defective snRNP assembly
Amyotrophic lateral sclerosis
Multiple sclerosis
Poliomyelitis
Tabes dorsalis
Vitamin B12 deficiency
Cauda equina syndrome
Conus medullaris syndrome
  • Damage (e.g., trauma) to the spinal cord segments T12–L2

References:[5]

Definition

  • Damage to the anterior two-thirds of the spinal cord, usually as a result of reduced blood flow or occlusion to the anterior spinal artery (ASA) anterior spinal artery syndrome (∼ 95% of cases) [6]

Etiology [7]

Clinical features

Vibration and proprioception are typically spared because of an intact dorsal column.

Diagnostics

Treatment

Prognosis

  • 10–15% functional recovery
  • If no recovery is evident and progressive after 24 hours, the prognosis is poor.

Autonomic symptoms are generally absent in Brown-Séquard syndrome because of unilateral involvement of the descending autonomic fibers.

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  3. Vargas MI, Gariani J, Sztajzel R et al.. Spinal cord ischemia: practical imaging tips, pearls, and pitfalls. AJNR Am J Neuroradiol. 2015; 36 (5): p.825-830. doi: 10.3174/ajnr.A4118 . | Open in Read by QxMD
  4. Hoehmann CL, Hitscherich K, Cuoco JA. The Artery of Adamkiewicz: Vascular Anatomy, Clinical Significance and Surgical Considerations. Int J Cardiovasc Res. 2016; 5 : p.6. doi: 10.4172/2324-8602.1000284 . | Open in Read by QxMD
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  10. Tamori Y, Takahashi T, Suwa H, et al. Cervical Epidural Abscess Presenting with Brown-Sequard Syndrome in a Patient with Type 2 Diabetes. Internal Medicine. 2010; 49 (14): p.1391-1393. doi: 10.2169/internalmedicine.49.3419 . | Open in Read by QxMD
  11. Scivoletto G, Di donna V. Prediction of walking recovery after spinal cord injury. Brain Res Bull. 2009; 78 (1): p.43-51. doi: 10.1016/j.brainresbull.2008.06.002 . | Open in Read by QxMD
  12. McKinley W, Santos K, Meade M, Brooke K. Incidence and Outcomes of Spinal Cord Injury Clinical Syndromes. J Spinal Cord Med. 2007; 30 (3): p.215-224.