Spinal Cord Syndromes

[Music] and then there's a bunch of different spinal cord syndromes that you need to be aware of anterior cord syndrome central cord system and bronchocard syndrome and we'll talk a little bit about each of them in terms of trauma anterior cord syndrome is very rare almost never seen it's most common in disciples where you get infarction of the anterior spinal artery and you have no motor sensory function below the level of injury but you have retained dorsal column function unusual in trauma central cord syndrome like i said is super common probably the the most common spinal cord injury that we see and it's and we'll we'll talk specifically about how those patients present in a second and then brown cycad syndrome is more common in penetrating trauma like knife injuries or gunshot wounds where you get a hemisection of the cord you'll have ipsilateral motor paralysis and contralateral loss of pinprick um and that's that's a brown cicard syndrome ipsilateral loss of dorsal column function so ipsilateral loss of proprioception um and so we again we've talked about all this anterior spinal cord syndrome is rare acute traumatic syndrome uh spinal cord syndrome super common and what defines it is basically patients who present with severe hand weakness greater than arm weakness or leg weakness so they they're paralyzed in their hands but their leg leg uh power is pretty normal it's pretty classic elderly patients hyperextension injury with uh in buckling of lincolmentum flavum in an area of pre-existing stenosis the sensory loss is typically incomplete and patients tend to improve over time so this this picture is probably 65 years old it was drawn by netter and almost everything in it is correct except for the bottom left figure but again older patient hyper extension of the neck has in-buckling of the ligamentum flavum compression of the cord weak hands uh and strong legs and the the reason why was called central cord syndrome it was always thought because there's an area of central damage to the cord that the cortical spinal tract is somatotopically organized and you're preferentially picking off the upper limb fibers while the lower limb fibers remain intact and if you look at any textbook grey's anatomy greenberg you know the neurology textbooks harrison's internal medicine all of them have this figure which always drove me uh crazy and i'll and i'll tell you why uh so there's a bunch of uh syndromes in addition to uh central court syndrome bell's cruciate paralysis is basically central cord syndrome with a patient who has an upper cervical cord injury and it was described by pell but they present similarly with weak hands strong legs and it was also felt that the reason for this differential you know presentation of arms and legs is that there was a decussation difference in the arm and leg fibers at the cervical medullary junction we know that the corticospinal tract decasates at the medullary pyramids and he hypothesized based on some old literature that they decided at different levels that you picked up the picked off the arm fibers and that's why you got weak legs so this leads to this here and it's very timely because we just uh published this literally this weekend it came out in journal neurosurgery um as the front cover and it is it's basically entitled uh a critical reappraisal of corticospinal tract somatotopic and and and the gist of the paper is and you'd have to read the paper to really sort of understand the reasons behind it and we don't have enough time to go into the details but but it basically says that you know these pictures from grey's anatomy greenberg and from uh the adams and victor which is the principle neurology text is incorrect there is no somatic topic organization cortical spinal tract even though there is for cement for the spinal thalamic and the dorsal columns and that really that the basis for the problems with hand function is that the corticospinal tract which is uniquely human and we need you know that there's major evolutionary differences in the corticospinal tract between a rat and a human is predominantly important for hand function and if you get a diffuse injury to the corticospinal crack it it will be manifest with weak hand so that that's basically the the gist of the paper and this figure is actually on on the front cover of the journal nerve surgery april uh issue so the the brown sacard syndrome we've already talked about there's also conus medullaris syndrome which is involving the conus of the spinal cord where you get prominent autonomic dysfunction um because of injury to the conus so loss of bowel bladder dis function and usually a combination of upper and lower motor neuron findings that's a conus syndrome as opposed to a cot aquinas syndrome which is typically below l1 l2 and it's a pure peripheral nerve injury so no hyperreflexia only hyporeflexia tends to be asymmetric tends to have prominent autonomic dysfunction and has a slightly better potential for recovery than a conus syndrome hey everyone ryan rad here from neurosurgerytraining.org if you like that video subscribe and donate to keep our content available for medical students across the world

Channel: Brain & Spine Group

Views: 8,660

Keywords: Medical Student Neurosurgery Training Center, brain and spine group, Spinal Cord Syndromes, spinal cord injury, central cord syndrome, spinal cord, anterior cord syndrome, spinal cord syndromes, medical school, spinal cord injury nursing, spinal cord injury recovery, spinal cord injury simple nursing, spinal cord injury story, spinal cord injury treatment, spinal cord injury registered nurse rn, spinal cord injury levels, spinal cord injury exercise

Id: 3bfa-nAqfcQ

Length: 6min 47sec (407 seconds)

Published: Mon May 09 2022