Neobook — clinical reference

Neurological syndromes
Central cord syndrome
Anterior cord syndrome
Brown-Séquard syndrome

Neurologic Syndromes

While most spinal cord injuries are complete, a significant number of patients present with well-defined neurologic syndromes corresponding to specific incomplete neuro-anatomic lesions.

Central cord syndrome

This syndrome is the result of a forced hyperextension injury, which causes the ligamentum flavum to buckle into the cord, resulting in a central contusion. The most medial portions of the spinothalamic tract, corticospinal tract, and dorsal column are affected. The syndrome is especially common in elderly patients. Patients with the central cord syndrome typically have more upper-extremity motor and sensory loss than they do in the lower extremities. It is often called the “burning-hand syndrome,” for obvious reasons. The majority of these patients will regain neurologic function to some degree.

The anterior cord syndrome involves bilateral injury in the distribution of the anterior spinal artery—that is, the corticospinal and spinothalamic tracts, with sparing of the dorsal columns. Hyperflexion is the most common mechanism of injury. This results in the loss of sensory and motor function below the level of injury with preserved position and vibration sense. Because this syndrome may be due to a correctable vascular injury, obtain immediate neurosurgical consultation.

Brown-Séquard - The Brown-Séquard syndrome, also known as hemisection of the spinal cord, is extremely uncommon in blunt injuries and is usually the result of penetrating trauma. When present in a patient with a blunt mechanism a lateral mass fracture should be suspected. This syndrome results in the contralateral loss of pain and temperature sensation as well as ipsilateral motor paralysis and ipsilateral loss of position and vibratory sensation (all distal to the lesion). This produces the notable physical finding in which the patient can feel a pinprick on his or her paralysed side. Recovery is sporadic, although most regain the ability to ambulate.