Definition
- Sensory and/or motor sparing in the sacral segments S4-5
Summary
Syndrome | Description | Aetiology |
Complete transection | Complete motor and sensory loss below level of lesion | Trauma, transverse myelitis, infarction, tumor, abscess |
Hemisection (Brown Sequard syndrome) | Ipsilateral motor UNTN (LNTN al level of lesion) Ipsilateral proprioception and vibration loss Contralateral pain an temperature loss from two levels below (crossed lateral spinothalamic tract) | Penetrating trauma, MS, tumor, abscess |
Anterior cord syndrome | Bilateral flaccid paralysisBilateral pain and temperature loss Proprioception, fine touch and vibration s ared tonomic dysfunction (hypotension) Bladder and bowel dysfunction | Hyperflexion, disc, anterior spinal artery infarct, post AAA repair |
Central cord syndrome | Shawl-like/suspended pain + temperature loss Dissociative anesthesia; hyperpathiaTouch and propioception perserved initially motor impairment: UL > LL, Distal > Proximal Sacral sparing Horner syndrome | Hyperextension, syringomyelia, tumour |
Posterior cord syndrome (posterior spinal artery syndrome) | Isolated Loss of propioception and vibration | Rare |
Posterior column syndrome | Impaired LL proprioception and vibrationTactile and postural hallucinations Sensory ataxia —Rhomberg positive | Neurosyphilis, Diabetes |
Posterolateral column disease | UMN deficit Loss of proprioception and vibration in legs Sensory ataxia—Rhomberg positive Bladder involvemenl | Subacute combined degeneration of the cord |
Conus medullaris syndrome | Both LIMN and LMN deficit Neurogenic bladder | T12/L1 fractures/tumours |
Cauda equina syndrome | Perianal and genital (saddle) anesthesia Bladder/bowel/sexual dysfunction Associated sciatica, LIMN motor deficit and asymmetric sensory loss | Disc herniation, tumor, abscess |
The term invokes an incorrect pathophysiology
- Marchi degeneration and neuroanatomic tracer studies have revealed absence of somatotopic organization to the CST.
- Autopsy and MRI studies have shown central hemorrhage is rare; there is diffuse axonal damage to the lateral columns.
- Monkey transection experiments have demonstrated that the CST is most important for hand function.
The clinical course is not too different
- See Pouw et al 2011