Here is an overview of spinal cord injury syndromes.
CENTRAL CORD SYNDROME:
Injuries to the central cord region typically affect the spinothalamic tract (pain and temperature) and the corticospinal tract (motor).
Etiologies:
Typically due to hyperEXTENSION
Incomplete lesion
Develops due to poor blood flow of the spinal cord
Degenerative joint disease – the vignette might be about an old person with OA
Classic features:
Symptoms are worse in upper extremities compared to lower extremities (this is the testable feature!)
Sensory and motor deficits
Variable prognosis
ED management:
Intubate if the injury is higher than C5
If you must intubate, consider video laryngoscopy to avoid the further hyperextension of direct laryngoscopy
ANTERIOR CORD SYNDROME:
Etiologies:
Direct injury: HyperFLEXION injury; crush or compression from a hematoma; just think of it as the neck crushing down on the anterior column.
Incomplete lesion
Indirect injury: ischemia to anterior spinal artery
Classic features:
Loss of motor, pain, and temperature below the level of injury
Posterior column features are preserved – e.g. touch, proprioception, and vibration
Bad prognosis :-(
BROWN-SEQUARD SYNDROME:
Etiology:
Usually penetrating trauma
These question stems might involve a “stab to the back”
Classic features:
Hemisection of spinal cord
Ipsilateral motor paralysis
Contralateral sensory loss of pain and temperature
I know you’ll never forgive me if I don’t include a quick reminder about the spinal column. If you’re struggling to keep things straight, just reminder that the posterior columns are responsible for proprioception, touch, and vibration. See below for pictures.
References:
Rosh Review :)
