SPINAL CORD SYNDROMES: TYPES, CAUSES AND SYMPTOMS - MEDICINE - 2024

The medullary syndromes, diseases or injuries of the spinal cord are common heterogeneous set of bit pathologies affecting this structure. Despite their infrequency, they cause serious sequelae that lead to significant disability. For this reason, early diagnosis is essential to start the appropriate treatment as soon as possible.

The spinal cord is part of the central nervous system and runs from the medulla of the brain to the lumbar region. Its main function is to exchange information between the brain and the rest of the body, through ascending and descending nerve fibers.

The main functions of the spinal cord are the perception of touch, vibrations, pressure, pain and temperature. In addition to producing movements and proprioception (feeling our own body components), it also controls the bladder, bowel, and basic sexual functions.

Each part of the spinal cord corresponds to a function and place in the body. Thus, if a spinal syndrome covers a certain area of ​​the spinal cord, only the legs, hands, or from the chest down, for example, may be affected.

Spinal cord syndromes can occur at any level of the spinal cord, producing symptoms from the damaged area down.

These syndromes are also often classified as traumatic (due to trauma) or myelopathies (disorders of the spinal cord that are not due to trauma).

Another distinction made from spinal syndromes is whether they are complete or incomplete. The former cover an entire segment of the spinal cord, while the latter only damage a part of it.

Types of spinal syndromes

Spinal cord

Here are the different spinal syndromes. I explain the symptoms, causes and location of the damage of each one of them; as well as your forecast.

Complete spinal cord involvement

This is a complete spinal cord injury, in which all functions below the damage are lost.

Spinal cord marked in blue. Source: Leandromartinez via Wikimedia Commons

Thus, both corticospinal (motor), spinothalamic (responsible for touch, pain and temperature) and dorsal (sensation of pressure, vibration or proprioception) functions are interrupted. Symptoms are flaccid paralysis, total anesthesia, absence of reflexes below the injury, loss of urinary and bowel control, and sexual dysfunction.

Cross section of the spinal cord. Source: User: Polarly via Wikimedia Commons

The prognosis is usually negative, with high mortality rates and little chance of recovery.

It can appear from traumas, heart attacks, tumors, abscesses, or transverse myelitis. The latter is a neurological disorder that causes complete inflammation in a segment of the spinal cord.

This inflammation can destroy myelin, an insulating substance essential for nerve transmission. Symptoms can last from hours to weeks.

Anterior cord syndrome

It involves damage to the front of the spinal cord or decreased blood flow in the anterior spinal artery. It is usually due to heart attacks, fractures, vertebral dislocations or herniated discs.

It produces a total motor deficit below the level of the injury. Motor function, perception of pain and temperature are lost. Tactile, vibratory and proprioceptive sensitivity is preserved.

However, symptoms can vary depending on whether the injured area is more localized or broader. Their prognosis is usually poor, with only 10-20% recovering.

Central or centromedullary syndrome

It is the most common and is usually due to an injury that affects the cervical spinal cord. It is a lesion in the gray matter inside the spinal cord.

Weakness is observed mainly in the upper extremities (arms), as well as lack of sensitivity to pain, touch, temperature and pressure below the level of the injury. It also causes bladder dysfunction, specifically urinary retention.

Its most common causes are syringomyelia or cyst within the spinal cord, hyperextension or flexion of the neck due to falls, vehicle accidents, blows or spinal stenosis.

Posterior cord syndrome

It accounts for less than 1% of all injuries due to trauma. Only the dorsal columns are affected and mainly affects sensitivity, but not functionality.

That is, these patients can walk, feel pain and temperature. But they cannot perceive vibrations below the level of injury and proprioception is lost.

It can arise from untreated syphilis, posterior spinal artery occlusion, Friedrich's ataxia, or bone marrow degeneration due to lack of vitamin B12.

Brown Sequard syndrome

It is rare, representing between 1 and 4% of all spinal cord injuries due to trauma. It occurs when one half of the cord is injured or affected, or is hemisected.

It causes a series of symptoms in the same half of the body where the injury occurred: loss of motor function, proprioception, sensation of touch and vibration. While on the opposite side (contralateral to the injury), there is loss of pain and temperature sensation.

It is usually the result of injuries to only one side of the spinal cord from guns or knives (penetrating trauma). Or it may be due to fractured vertebrae or tumors.

Medullary cone syndrome

It consists of damage to the end of the spinal cord, around the L1 lumbar nerves. The nerve roots that leave this area are called “cauda equina” and if they are affected it is called “cauda equina syndrome”, although it is not a medullary syndrome in itself.

Both can be injured due to their proximity; its usual causes are physical trauma, ischemia, and tumors.

This area has the spinal segments S4 and S5, which are those that control the bladder, the intestine and certain sexual functions.

For this reason, there may be alterations in the functioning of the bladder such as retention, increased urinary frequency or incontinence. In addition to reduced muscle tone in the anal sphincter, fecal incontinence, erectile dysfunction, variable weakness of the lower extremities, etc. There is also a loss of perianal and perineal sensation called “saddle anesthesia”.

If only the “cauda equina” nerves are affected, the symptoms are very similar, but with weakness, paralysis, or pain on only one side of the body. Cauda equina syndrome is usually due to a fractured intervertebral disc or a tumor.

The latter has a better prognosis than medullary cone syndrome, since the peripheral nervous system recovers more easily than the central one.

References

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