based on snells clinical anatomy and lippincotts functional anatomy

1. SPINAL CORD ANATOMY
AND
SPINAL CORD SYNDROMES
DR. SACHIN ADUKIA

18. SYNDROMES OF SPINAL CORD
 It is divided into complete and incomplete cord
syndromes.
 INCOMPLETE CORD SYNDROMES.
 Brown Sequard syndrome.
 Central cord syndrome.
 Anterior cord syndrome.
 Posterior cord syndrome.
 Conus medullaris syndrome.
 Cauda equina syndrome.

19. COMPLETE CORD TRANSECTION

20. Complete transection of spinal cord
 Causes
 Trauma
 Metastatic carcinoma
 Multiple sclerosis
 Spinal epidural haematoma
 Autoimmune disorders
 Post vaccinial syndromes.
 All ascending tracts from below and descending tracts
from above are interrupted.
 Affects motor sensory and autonomic functions.

21.  SENSORY
 all sensations are affected.
 Pin prick test.
 Sensory level is usually 2 segments below the level of lesion.
 Segmental paresthesia occur at the level of lesion.
 Motor-paraplegia due to corticospinal tract.
 First spinal shock-followed by hypertonic hyperreflexic
paraplegia.
 Loss of abdominal and cremastric reflexes.
 At the level of lesion LMN signs occur.
 Autonomic-
 Urinary retention and constipation.
 Anhidrosis ,trophic skin changes, vasomotor instability below
the level of lesion.
 Sexual dysfunction can occur.

22. Brown Sequard Syndrome

23. Central cord syndrome

24. CENTRAL CORD SYNDROME
 MC: syringomyelia.
 others : hyperextension injuries of neck,
intramedullary tumours,trauma.
 Associated with Chiari Type 1 and 2 and Dandy Walker
malformation.
 SENSORY
 Pain and temperature are affected.
 Touch and proprioception are preserved.
 Dissociative anaesthesia.
 Shawl like distribution of sensory loss.
 MOTOR.
 Upper limb weakness >lower limb

26. Other features:
 Horners syndrome
 Kyphoscoliosis
 Sacral sparing
 Neuropathic arthropathy of shoulder and elbow joint
 Prognosis is fair.

27.  Occurs due to neurosyphilis, diabetes mellitus
 Usually occurs 10 to 20 yrs after infection
POSTERIOR COLUMN SYNDROME

28.  SENSORY
 Impaired position and vibration sense in LL
 Tactile and postural hallucinations can occur.
 Numbness or paresthesia are frequent complaints..
 Sensory ataxia.
 Positive Rhomberg sign.
 Positive Sink sign
 Positive Lhermitte.s sign.
 Abadie’s sign positive.
 Urinary incontinence.
 Absent knee and ankle jerk.(areflexia, hypotonia)
 Abdominal and laryngeal crisis can occur.
 Charcot’s joint.

29. ANTERIOR CORD SYNDROME.

30. ANTERIOR CORD SYNDROME

31.  Conus medullaris is frequently involved.
 Lies opposite to vertebral bodies T12 and L1.
 Neck pain of sudden onset.
 MOTOR
 Flaccid and areflexic paraplegia
 SENSORY
 Loss of pain and temperature.
 Preservation of positon and vibration.
 AUTONOMIC
 urinary incontinence
 Occurs due to syphilitic arteritis ,aortic dissection, atherosclerosis of aorta,
SLE, AIDS,AV malformation

33. CONUS MEDULLARIS SYNDROME
 Contributes to 25%spinal cord injuries.
 Lies opposite to vertebral bodies of T12 and L1.
 Caused by flexion distraction injuries and burst
fractures.
 Both UMN and LMN deficits occur.
 Development of neurogenic bladder.

34. CAUDA EQUINA SYNDROME.
•Begins at L2 disc space distal to conus medullaris.
•Occurs due to acute disc herniation epidural haematoma, tumour
•MOTOR
•Flaccid lower extremities.
•Knee and ankle jerk absent.
•SENSORY-Asymmetrical sensory loss
•Saddle anaesthesia
•Loss of sensation around perineum, anus, genitals.
•AUTONOMIC-
•Loss of bladder and bowel function.
•Urinary retention.

37. References
 Haines DE. Lippincott's Illustrated Q&A Review of
Neuroscience. Lippincott Williams & Wilkins; 2010
Oct 27.
 Daroff RB, Jankovic J, Mazziotta JC, Pomeroy SL.
Bradley's neurology in clinical practice. Elsevier
Health Sciences; 2015 Oct 25.

38. THANK YOU