A 40 years old male after A, attains spinal injury. His lower limb power is greater than that of upper limb and sacral sensations are present. Type of spinal cord lesion is:
A i.e. Central cord syndrome Central cord syndrome is defined by American spinal injury Association (ASIA) as a clinical presentation, characterized by "dissociation" in degree of motor weakness weakness with lower limbs stronger than upper limbs and sacral sparing presentQ Complete lesion (transection) No motor or sensory function in the lowest sacral segments (S4 - Ss)/ below the level of spinal cord injuryQ 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 (& may be neuroprexia). And it should not be taken as 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 great toe) may be the only sign of paially functioning spinal cord or incomplete lesion. Central Cord Syndrome It occurs d/t damage of spinal cord near central canal area. Main causes are hyperextension trauma, Syringomyelia, tumor and anterior spinal aery ischemia. It is most frequent of incomplete cord syndromes and occurs most frequently in elderly people with underlying degenerative spolidylosis. Dissociative motor weakness with arm weakness out of propoion to leg weaknessQ Sacral sensory sparingQ - 'Dissociated sensory loss' signifying a loss of pain and temperature sense (lateral spinothalmic 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 following order- 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 & coicospinal tracts (located in the anterior aspect of spinal cord) are injured with preserv-ation of dorsal columns - Variable loss of pain and temperature sensation and motor functions with preservation of proprioceptio n, vibrator sense and deep pressure sensationQ Brown Sequard Syndrome It is functional hemisection of spinal cord 1/t motor weakness on ipsilateral side of lesion & sensory deficit on the contralateral side (in broad terms.) It consist of ipsilateral motor (coicospinal tract) and propriaception (posterior column) loss and contralateral pain & temperature (spinothalmic tract) sensory lossQ. 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 spinothalmic and coicospinal tracts. - Loss of position and vibratory sense below the level of injury
Central cord syndrome
Anterior cord syndrome
Posterior cord syndrome
Complete spinal cord injury.