Critical Care Medicine-Neurologic Disorders>>>>>Spinal Cord Injury
Question 5#

A 40-year-old male is admitted to the ICU after being stabbed in the back during a bar fight. Neurological examination reveals loss of all sensation at the T8 level, loss of proprioception and vibration below T8 on one side, and loss of pain and temperature sensation below T8 on the other side. Motor strength is impaired on the same side as loss of proprioception and vibration.

Which of the following syndrome best describes the findings on neurological examination in this patient?

a. Brown-Sequard syndrome (BSS)
b. Central cord syndrome
c. Anterior cord syndrome
d. Complete spinal cord injury (SCI)

Correct Answer is A

Comment:

Correct Answer: A

Incomplete SCI is defined as partial injury to the cord that results in varying degrees of residual sensory and motor function. The site of the injury dictates the findings on neurological examination. BSS or lateral hemi-section syndrome represents a spinal cord hemisection in its pure form. It involves injury to the dorsal column, corticospinal tract, and spinothalamic tract unilaterally, which results in weakness, loss of vibration, and proprioception ipsilateral to, and loss of and temperature sensation contralateral to the injury. Sensory loss of all modalities at the level of the lesion is often seen. BSS is usually secondary to penetrating SCI but can be rarely seen from transverse myelitis after influenza vaccination or a ruptured pheochromocytoma. Management is conservative with aggressive early rehabilitation. Surgical intervention is indicated in the presence of cerebrospinal fluid leak, persistent spinal cord/root compression, or progressive deterioration. BSS demonstrates a favorable prognosis compared with other types of incomplete spinal cord injuries.

Central cord syndrome is the most common of the clinical syndromes, often seen in individuals with underlying cervical spondylosis who sustain a hyperextension injury (most commonly from a fall) and may occur with or without fracture and dislocations. This clinically presents as an incomplete injury with greater weakness in the upper limbs than in the lower limbs.

The anterior cord syndrome is a relatively rare syndrome that historically has been related to a decreased or absent blood supply to the anterior twothirds of the spinal cord. The dorsal columns are spared, but the corticospinal and spinothalamic tracts are compromised. The clinical symptoms include a loss of motor function, pain sensation, and temperature sensation at and below the injury level with preservation of light touch and joint position sense.

Complete SCI would lead to complete paralysis and absence of sensation below the level of the injury.

References:

  1. Moskowitz E, Schroeppel T. Brown-Sequard syndrome. Trauma Surg Acute Care Open. 2018;3:e000169.
  2. Kirshblum SC, Burns SP, Biering-Sorensen F, et al. International standards for neurological classification of spinal cord injury (revised 2011). J Spinal Cord Med. 2011;34:535-546.