Cervical spine fractures
Charles M Court-Brown, Margaret M McQueen, Marc F Swiontkowski, David Ring, Susan M Friedman, Andrew D Duckworth in Musculoskeletal Trauma in the Elderly, 2016
Spinal cord injuries are devastating, especially to the elderly where the chance of mortality is greater than 80%. Various spinal cord injury patterns are seen. A complete cord injury is where there is no motor sensory function below the level of injury. Incomplete patterns include anterior cord, Brown-Sequard, central cord and posterior cord syndromes. Anterior cord syndrome causes loss of function of distal motor and pain and temperature functions due to injury of the anterior two-thirds of the spinal cord. Only posterior cord function remains. The prognosis is extremely poor. Brown-Sequard syndrome is a hemi-cord injury where there is ipsilateral loss of motor function and contralateral loss of sensory function. Central cord syndrome is a common injury pattern seen in elderly patients due to pre- existing cervical stenosis. In this syndrome there is greater loss of upper extremity function than lower extremity function. This pattern of neurologic injury is due to the lamination of axonal tracks where the upper extremities are more medial and thus affected to a greater degree in central cord syndrome than the more laterally placed lower extremity tracts. This prognosis is variable and many patients can make a significant recovery. Posterior cord syndrome is rare; there is only loss of dorsal column function and thus light touch, proprioception and vibration.
Trauma
Sam Mehta, Andrew Hindmarsh, Leila Rees in Handbook of General Surgical Emergencies, 2018
Incomplete spinal injury (seeFigure 4.2) may result in: Brown–Séquard syndrome: this is often due to a penetrating injury and occurs because of hemisection of the cord with loss of ascending and descending spinal cord tracts on that side. There are bilateral signs with ipsilateral paralysis and loss of proprioception, and contralateral loss of pain and temperature sensationcentral cord syndrome: usually due to a hyperextension injury in a patient with long-standing cervical spondylosis. This affects decussating fibres of the spinothalamic tract. Medial fibres are affected first, and therefore motor and sensory impairment in the upper extremities is usually greater than in the lower extremities. Characteristically there is ‘sacral sparing’anterior cord syndrome: due to a flexion injury. This results in motor paralysis and loss of pain/temperature sensation. Proprioception is intact.
Back and central nervous system
Aida Lai in Essential Concepts in Anatomy and Pathology for Undergraduate Revision, 2018
Brown–Séquard syndrome Complete hemisection of spinal cordContralateral impairment of pain and temperature sensation at level of hemisection (due to damage to spinothalamic tracts which have already undergone decussation)Ipsilateral hemiplagia, impaired proprioception, and vibration sense below level of hemisection (damage to dorsal columns)Ipsilateral LMN signs at level of hemisectionIpsilateral UMN signs below level of hemisection (damage to lateral corticospinal tract)
Clinico-radiological correlation and surgical outcome of idiopathic spinal cord herniation: A single centre retrospective case series
Published in The Journal of Spinal Cord Medicine, 2021
Deepak Menon, Sruthi S. Nair, Bejoy Thomas, K. Krishna Kumar, Muralidharan Nair
From our prospectively maintained data base and picture archiving system, we identified those patients who had been evaluated for myelopathy and myeloradiculopathy in whom alternative causes were excluded. Radiologically, ventral or ventrolateral displacement of spinal cord, presence of dorsal communicating dilated cerebrospinal fluid (CSF) space occupying the normal cord position(after excluding arachnoid cyst) with or without associated cord atrophy or intrinsic cord signal changes were considered features of ISCH.2 From the database, the clinical presentation of patients was obtained through chart review. Along with the clinical presentation, differential diagnosis entertained and management aspects along with the clinical status at the last follow-up was collected. We identified eight patients with ISCH over a ten-year period. Brief clinical description of representative cases presenting with Brown-Sequard syndrome, pure spastic paraparesis, radiculopathy and girdle sensation are given below. Table 1 shows a summary of the clinical and radiological features of all patients.
Related Knowledge Centers
- Decompression Sickness
- Inflammation
- Proprioception
- Spinothalamic Tract
- Upper Motor Neuron
- Neoplasm
- Tuberculosis
- Multiple Sclerosis
- Corticospinal Tract
- Dorsal Column–Medial Lemniscus Pathway