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Spinal cord syndromes
Which tracts each cord syndrome hits, and the motor and sensory pattern that lets you name it at the bedside.
| Syndrome | Typical cause | Motor | Sensory | Other clues |
|---|---|---|---|---|
| Anterior cord (anterior spinal artery) | Aortic surgery or dissection (loss of the artery of Adamkiewicz), hypotension, flexion injury | Paraplegia or quadriplegia below the lesion | Loss of pain and temperature; vibration and proprioception preserved (dorsal columns spared) | Bladder dysfunction |
| Central cord | Hyperextension in an older patient with cervical spondylosis | Weakness greater in the arms than the legs | Variable | Arms worse than legs is the giveaway |
| Brown-Séquard (hemisection) | Penetrating trauma, tumor, MS | Ipsilateral UMN weakness below the lesion | Ipsilateral loss of vibration and proprioception; contralateral loss of pain and temperature starting 1–2 levels below | Follows from where each tract crosses (see notes) |
| Syringomyelia | Central cervical syrinx, often with Chiari I malformation or after trauma | Later LMN weakness and wasting of the hands; UMN signs in the legs | Bilateral cape-like loss of pain and temperature over the shoulders and arms, with touch and vibration preserved | Painless burns of the hands; MRI of the cervical cord |
| Subacute combined degeneration (dorsal columns + lateral corticospinal tracts) | Vitamin B12 deficiency, nitrous oxide abuse, copper deficiency | UMN signs (spasticity, Babinski) with reduced ankle reflexes | Symmetric distal loss of vibration and proprioception; positive Romberg | Macrocytic anemia, raised methylmalonic acid |
| Tabes dorsalis | Tertiary syphilis (dorsal roots and columns) | Absent reflexes | Sensory ataxia, positive Romberg, lightning pains | Argyll Robertson pupils, Charcot joints |
| Conus medullaris | Fracture, tumor or disc at about L1–L2 | Mixed UMN and LMN (e.g. brisk knee jerk with absent ankle jerk) | Perianal numbness | Sudden and symmetric, with early bladder, bowel and sexual dysfunction |
| Cauda equina | Large central disc herniation (L4–L5 or L5–S1), tumor, epidural abscess or hematoma | LMN leg weakness with reduced reflexes | Saddle anesthesia; bilateral (sometimes unilateral) sciatica | Urinary retention with overflow, reduced anal tone — emergency MRI and decompression |
The dorsal column–medial lemniscus pathway crosses in the medulla, so a cord lesion causes ipsilateral loss of vibration and proprioception. The spinothalamic tract crosses within a level or two of entry, so cord lesions cause contralateral pain and temperature loss. The corticospinal tract has already crossed in the medulla, so cord lesions cause ipsilateral weakness.
Neurogenic shock (hypotension with bradycardia) follows cervical or high thoracic cord injury, above about T6.