- Total loss of sensation from below the level of the lesion
- Initial flaccid paralysis (spinal shock) leading to spastic paralysis
- Immediate loss of reflexes, which begin to recover at 2 weeks but may take up to 6 weeks to recover
- Flexor and anogenital reflexes are the first to recover
- Arterial blood pressure becomes labile due to autonomic hyperactivity
- Loss of voluntary sphincter tone
- Lesions at the level of C4 and above tend to be fatal due to diaphragmatic paralysis via the phrenic nerve
Spinal cord hemi-section (Brown-Sequard syndrome)
- Caused by lateral cord damage e.g. osteophyte impaction on half of the cord producing sensorimotor damage at the level of the injury
- Leads to:
- Ipsilateral paralysis (due to transection of the lateral corticospinal [pyramidal] tract)
- Ipsilateral dorsal column effects (proprioception, touch, vibration)
- Contralateral spinothalamic effects (pain and temperature)
Anterior spinal artery syndrome (a.k.a. anterior cord syndrome)
- Interruption of blood flow through the (single) anterior spinal artery
- May occur due to occlusion of the artery of Adamkiewicz
- Clinical features:
- Paraplegia (i.e. bilateral loss of motor function) below the level of lesion
- Bilateral loss of temperature/pain sensation below the level of the lesion
- Bilateral loss of sympathetic outflow, leading to hypotension
- Loss of parasympathetic outflow causes bowel incontinence, urinary retention and sexual dysfunction
- There is preservation of the dorsal columns i.e. fine touch and proprioception are unaffected
- Arises due to disruption of the central grey matter of the spinal cord e.g. from bleeding, oedema, infarction
- Typically follows some C-spine injury, leading to an incomplete spinal cord injury
- Causes:
- Variable degree of sensory loss below the level of the injury, but typically affects spinothalamic pathways to a greater extent
- Motor deficit, typically greater in the upper limbs vs. the lower limbs
- Sacral nerve fibres are positioned laterally in the cord and the patient may demonstrate sacral sparing of sensory loss
- A rare syndrome associated with damage to the posterior spinal arteries
- Produces loss of fine touch, vibration and proprioception below the level of the lesion
- Damage to the cauda equina below the conus medullaris (L5 - S1) causes the characteristic syndrome of:
- Upper motor neurone weakness and altered sensation in both lower limbs
- Saddle anaesthesia
- Decreased anal sphincter tone
- Bladder dysfunction
- Bowel dysfunction
- Sexual dysfunction
- A cystic degenerative condition affecting the centre of the upper part of the spinal cord
- Initially affects the decussating spinothalamic pathways and therefore bilateral upper limb pain and temperature sensory loss is the presenting symptom
Lumbosacral anterior horn cell damage
- Reduced lower limb tendon jerk reflexes