Incomplete Patterns of Spinal Cord Injury
July 10, 2009 by Dr Arun Pal Singh
Filed under Spine Injuries
Each case of of spinal cord injury is unique and needs to be assessed in detail. A complete injury of the spinal cord results in total loss of sensations and motor control at or below the level of injury. However in incomplete injuries there might emerge some patterns of neurological distribution that may indicate towards type and level of injury.
These patterns result from typical arrangement of neural fibres in the spine. These are the common injury patterns when the lesion is incomplete. However, it must be remembered that not every case would present with classical picture of these lesions. There would be pointers but all the features might not be present.
Bell’s cruciate paralysis
The lesion is at the level of decussation of motor fibers in brainstem. the patient would present with variable cranial nerve involvement. Weakness of upper is greater than lower limbs and weakness is more pronounced tin proximal part of the limb than distal.
Wallenberg’s hemiplegia
The injury is in one side of brainstem. the picture might also occur in upper cervical spine injury. The clinical picture includes weakness od upper arm on one side and lower limb of the opposite side. there might be cranial nerve cranial nerve and brainstem involvement.
Anterior Cord Syndrome
The lesion is in anterior gray matter of spinal cord which affects descending corticospinal motor tract and spinothalamic tract. the dorsal column is preserved. the patient presents with loss of motor power below affected level of spine. There is loss of pain and temperature sensation.
However because dorsal column is not injured, there is preservation preservation of proprioception (awareness of joint movements) and deep pressure sensation.
Central Cord Syndrome
It is associated with cervical injuries whee central part of the cord is more affected. the patient presents with greater waekness of the upper limbs as compared to lower limbs.
Brown-Sequard Syndrome
The lesion is in lateral half of the cord and there is preservation of contralateral half. Clinical Presentation includes motor weakness on the same side including proprioception loss and contralateral pain and temperature sensory loss.
Conus Medullaris Syndrome
Lesion Injury to the sacral cord (conus) and lumbar nerve roots within the spinal canal. Clinical presentation is of areflexic bladder, bowel, and lower limbs resulting in paralysis and incontinence of bladder and bowel. Bulbocavernosus and micturition reflexes are preserved.
Cauda Equina Syndrome
There is an injury to the lumbosacral nerve roots within the spinal canal and is considered a surgical emergency. The patient presents with areflexic bladder, bowel, anaesthesia in perineum and medial aspect of thigh and lwer motor neuron weakness in lower limbs.
Root Injury Syndrome
The lesion consists avulsion or compression injury to single or multiple nerve roots (brachial plexus, sacral plexus injury). the patient presents with dermatomal sensory loss, myotomal motor loss, and absent deep tendon reflexes supplied by the affected roots.
Related posts:
- Understanding Spinal Injury – Complete and Incomplete Spinal Cord Injury
- Spinal Cord Injury and Concept of Cure
- Few Terms Used In Spinal Injury
- Reflexes of Spinal Cord and Conus Medullaris
- Spinal Injury – An Overview of Definitive Treatment
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