Examkin

Question

Difficulty: MediumNeurosurgery

A trauma surgery team frequently evaluates patients with acute spinal cord injuries following motor vehicle collisions and falls. Depending on the mechanism of injury and the specific anatomical tracts involved, distinct clinical patterns emerge. Match the following incomplete spinal cord and nerve root syndromes with their most characteristic neurological deficits.

  • Anterior cord syndromeBilateral loss of motor function, pain, and temperature sensation with preserved proprioception
  • Central cord syndromeDisproportionate bilateral motor impairment affecting the upper extremities more than the lower extremities
  • Brown-Séquard syndromeIpsilateral hemiplegia and loss of proprioception combined with contralateral loss of pain and temperature sensation
  • Cauda equina syndromeAsymmetric lower extremity flaccid weakness, saddle anesthesia, and hyporeflexia

Answer

Anterior cord syndrome matches with bilateral loss of motor/pain/temperature with preserved proprioception. Central cord syndrome matches with disproportionate upper extremity weakness. Brown-Séquard syndrome matches with ipsilateral hemiplegia/proprioception loss and contralateral pain/temperature loss. Cauda equina syndrome matches with asymmetric flaccid weakness and saddle anesthesia.
Matching each syndrome to its clinical deficit requires understanding the cross-sectional anatomy of the spinal cord. The dorsal columns carry ipsilateral proprioception/vibration, the lateral corticospinal tracts carry ipsilateral motor commands, and the spinothalamic tracts carry contralateral pain/temperature sensation. Lesions affecting specific regions produce predictable, distinct patterns of neurological loss.

Step-by-Step Solution

1
Analyze the anatomy involved in anterior cord syndrome.
Damage to the anterior two-thirds of the spinal cord (corticospinal and spinothalamic tracts) while sparing the dorsal columns.
This leads to paralysis and loss of pain/temperature sensation below the lesion, but intact joint position and vibration sense.
2
Analyze the anatomy involved in central cord syndrome.
Damage to the central gray matter and medial portions of the corticospinal tracts, usually in the cervical region.
Because cervical (upper extremity) motor fibers are located more medially within the corticospinal tract than sacral (lower extremity) fibers, the arms are affected more than the legs.
3
Analyze the anatomy involved in Brown-Séquard syndrome.
Hemisection of the spinal cord.
This severs the ipsilateral descending motor tracts and ascending dorsal columns, plus the ascending spinothalamic tracts which have already crossed over, resulting in a crossed sensory deficit.
4
Analyze the anatomy involved in cauda equina syndrome.
Compression of the lumbosacral nerve roots below the conus medullaris.
This results in peripheral nerve (lower motor neuron) symptoms rather than spinal cord (upper motor neuron) symptoms, leading to flaccid paralysis, hyporeflexia, and saddle anesthesia.

Key Concept

Clinical presentation of incomplete spinal cord and nerve root syndromes based on cross-sectional spinal anatomy.
Estimated Time:1m 30s
Rate this question

Topics

Neurosurgery

More questions from this topic