Spinal cord syndromes: types, causes and symptoms

Within the human body is the spinal cord, an extensive cord that is responsible for carry nerve impulses from the brain to the rest of the body and vice versa. Thanks to her we can make any movement, stay upright or perceive all kinds of sensations, both internal and external.

However, when it is injured or suffers some type of pathology spinal cord syndromes or myelopathies appear. The term spinal cord syndromes groups together a variety of disorders of the spinal cord with consequences that affect both motor skills and sensory abilities.

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What are spinal cord syndromes?

Spinal cord syndromes, or diseases of the spinal cord, refer to a diverse set of symptoms and signs that can vary depending on the location of the spinal cord injury.

Despite the fact that these conditions do not usually occur very frequently, they tend to cause serious effects and consequences on the person's health, leading, in many cases, some kind of disability.

This is the reason why a hasty diagnosis of these medullary syndromes, as well as an intervention effective therapy, it is essential to reduce or compensate in the best way the symptoms of these conditions.

We can distinguish several types of spinal cord syndromes based on the symptoms that each of them present. These symptoms are associated with specific etiological processes; that is, to the causes that have caused the damage or injury. These damages can affect the entire medullary cylinder or, conversely, damage only a part of the medulla in its cross section.

At the moment in which the medical professional has to make the diagnosis of one of these medullary syndromes, he must take into account the possibility that it is one of the conditions, such as some autoimmune, muscular or psychiatric diseases, that have a similar symptoms. An exhaustive differential diagnosis will be the key to carry out satisfactory treatment of the patient.

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Types of spinal cord syndromes

As mentioned above, there is a great variety of classic spinal cord syndromes. The main way to classify them is taking into account their symptoms, as well as their temporal pattern.

1. complete spinal cord injury

In those cases of complete spinal cord injury, or transverse myelopathy, the person will experience the disappearance of all sensory modalities, as well as a bilateral alteration of the motor pathways that are below the lesion.

This syndrome is characterized by presenting sensory symptoms and motor symptoms. The sensory symptoms typical of a complete spinal cord injury are:

• Paresthesias or abnormal sensations of tickling and changes in body temperature. These sensations occur in the section that corresponds to the level of the lesion.
• Localized pain in the vertebrae.
• Radicular pain according to the location of the lesion. If it is a cervical injury, the person will experience pain in the arms, while if it is a thoracic or lumbar injury, the pain will focus on the chest and abdomen or on the legs.
• low sensitive threshold or loss of all sensory modalities.

On the other hand, symptoms related to motor functions include:

• Injuries to the motor neurons inferiors that cause muscle atrophy, twitching or small muscle twitches that can be observed under the skin and hyporeflexia or decreased reflex response.
• Paraparesis/paraplegia or tetraparesis/quadriplegia. The person experiences paralysis or mobility problems, both to a variable degree, in the lower extremities or in all four extremities.

2. incomplete spinal cord injury

In cases of syndromes or incomplete spinal cord injuries, the spinal cord is not completely damaged at the transverse level, so that the person does not experience either total paralysis or a total loss of sensitivity.

Likewise, there are several types of incomplete spinal cord injuries that differ according to the set of symptoms they cause.

Medullary hemisection or Brown-Séquard syndrome

In this case the person suffers an alteration or damage in the hemimedulla. However, it is very difficult for this lesion to occur right in the midline of the spinal cord or for it to appear purely unilaterally.

The medullary hemisection may be caused by some type of infection or by an injury at that specific point. In addition, certain tumor bodies or degenerative diseases They can also cause this type of syndrome.

The symptoms of this condition usually appear at the ipsilateral level and below the level of the lesion, the most important being paralysis of the ipsilateral first motor neuron and lack of sensitivity to pain and temperature.

The symptoms of spinal cord hemisection include:

• homolateral paralysis.
• Thermoanalgesia or insensitivity to contralateral temperature.
• Muscle weakness and paralysis.
• Loss or decrease of sensitivity and sensory perception.
• Alterations in the perception of posture and position (proprioceptive system).

Centromedullary syndrome

In centromedullary type involvement, the damage is in the Gray matter central cord and in the spinothalamic tracts that traverse the central area of ​​the cord. In addition, this lesion can dissipate centrifugally, affecting other anatomic pathways.

Among the sensory symptoms we find a loss of sensation to pain and temperature. While at the motor level the person may experience muscle atrophy, fasciculations, muscle weakness and hyporeflexia.

Combined lesion of posterior and lateral cords

In this type of injury, the person may experience motor symptoms such as muscle weakness, spasticity or constant muscle contraction, hyperreflexia, and Babinski reflex, which involves dorsal extension of the big toe of the foot

On a sensory level, symptoms include alterations in the proprioceptive system and sensitivity to vibration.

Isolated lesion of posterior cords

In this case the damage is caused only in certain cords or posterior fibers. This lesion causes in the person an alteration of the proprioceptive and vibratory sensitivity, as well as ataxia or difficulties in the coordination of movements. Also, the person You may also experience shooting pain in your legs and urinary incontinence..

anterior horn syndrome

Compared with the rest of the conditions, in the anterior horn syndrome only pure motor symptoms of second motor neuron atrophy appear. These symptoms include fasciculations, muscle weakness, hypotonia, and hyporeflexia in one or several muscle groups. In addition, it also causes absence of reflections.

Combined pyramidal pathway and anterior horn syndrome

In this last syndrome of incomplete medullary nature, also only motor symptoms appear; with the difference that first and second motor neuron symptoms develop simultaneously within the same muscle group. The cause is an anomaly present in the pyramidal tracts and in the anterior horns.

3. Medullary vascular syndromes

Unlike the syndromes characteristic of complete and incomplete spinal cord injuries, in spinal cord vascular syndromes the origin of the anomaly is found in the an abnormality of blood flow in any area of ​​the spinal cord.

Medullary arterial ischemia syndromes

In this case, the suspension of the arterial blood supply in the medulla has as a direct result the appearance of strokes or transient ischemic attacks.

Spinal cord venous ischemia syndrome

These types of syndromes are much rarer than the previous ones. Besides, tend to affect the lower extremities, producing bilateral syndromes or complete transverse syndromes almost always in an asymmetric manner.

The main causes of this type of pathology are arteriovenous malformations, fibrocartilaginous embolisms and the effects of decompression.

Spinal hemorrhage syndromes

In these syndromes we can differentiate between intramedullary hemorrhage and extramedullary hemorrhage. The intramedullary is produced by a vascular rupture causing spinal pain, paresis and sensory alterations below the level of the lesion.

As for extramedullary hemorrhage, this is much more infrequent. In this case, the person experiences sharp spinal pain in the place where the effusion is located, together with symptoms similar to those of a cerebral subarachnoid hemorrhage. These include numbness in a part of the body, seizures, cervical tension, vision problems, nausea or muscle pain.