Spinal cord syndromes: types, causes and symptoms

These are the different diseases related to the malfunction of the spinal cord.

Inside the human organism is the spinal cord, an extensive cord that is in charge of transporting nerve impulses from the brain to the rest of the body and vice versa. transporting nerve impulses from the brain to the rest of the body and vice versa.. Thanks to it, we can perform any movement, stand upright or perceive all kinds of internal and external sensations.

However, when it is injured or suffers some kind of pathology, spinal cord syndromes appear. spinal cord syndromes or myelopathies appear.. The term of spinal syndromes groups a whole variety of affections of the medulla with consequences that affect so much to the motor abilities as to the sensitive capacities.

What are spinal syndromes?

Spinal 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 lesion. a diverse set of symptoms and signs that can vary depending on the location of the spinal cord lesion..

Although these conditions do not occur very frequently, they tend to have serious effects and consequences on a person's health, in many cases, leading to some form of disability..

This is the reason why a prompt diagnosis of these spinal syndromes, as well as an effective therapeutic intervention, is essential to reduce or compensate in the best way the symptomatology 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, with the causes that have provoked the damage or injury. These damages can affect the entire spinal cord cylinder or, on the contrary, damage only a part of the spinal cord in its transverse section.

When the medical professional has to diagnose one of these spinal syndromes, he/she must take into account the possibility that it may be one of the conditions, such as some autoimmune, muscular or psychiatric diseases, which have similar symptomatology. A thorough differential diagnosis will be the key to a satisfactory treatment of the patient. satisfactory treatment of the patient..

Types of spinal syndromes

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

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 motoras well as a bilateral alteration of the motor pathways below the lesion.

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

• Paresthesias or abnormal sensations of tingling and body temperature changes. These sensations occur in the section corresponding to the level of the lesion.
• Localized pain in the vertebrae..
• Radicular pain depending on the location of the lesion. If it is a cervical lesion, the person will experience pain in the arms, while if it is thoracic or lumbar, the pain will be centered in the thorax and abdomen or in the legs.
• Low sensory threshold or loss of all sensory modalities.

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

• Lower motor neuron lesions resulting in. muscle atrophy, fasciculations or small muscle contractions that can be seen under the skin which can be seen under the skin, and hyporeflexia or decreased reflex response.
• Paraparesis/paraplegia or tetraparesis/tetraplegia.. The person experiences paralysis or mobility problems, both to varying degrees, in the lower extremities or all four limbs.

2. Incomplete spinal cord injury

In cases of incomplete spinal cord injury or syndromes, the spinal cord is not completely damaged at the transverse level, so the person does not experienceIn cases of incomplete spinal cord injury, the spinal cord is not completely damaged transversely, so that the person experiences neither total paralysis nor total loss of sensation.

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

Spinal cord hemisection or Brown-Séquard syndrome

In this case the person suffers damage or alteration in the hemimédula.. However, it is very complicated for this injury to occur right in the midline of the medulla or to appear purely unilaterally.

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

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

Symptomatology of spinal hemisection includes:

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

Centromedullary syndrome

In centromedullary type involvement, the damage is found in the central gray matter and in the spinothalamic tracts that cross the central area of the medulla. In addition, this lesion may dissipate in a centrifugal manner affecting other anatomical pathways.

Sensory symptoms include a loss of sensitivity 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's reflex, which consists of dorsal extension of the big toe.

At the sensory level, symptoms include alterations in the proprioceptive system and vibration sensitivity..

Isolated lesion of posterior cords

In this case the damage is caused only in certain posterior cords or 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. In addition, the person may also experience stabbing pain in the legs and urinary incontinence..

Anterior horn syndrome

In comparison to the other conditions, only pure motor symptoms of second motor neuron atrophy occur in anterior horn syndrome. These symptoms include fasciculations, muscle weakness, hypotonia and hyporeflexia in one or more muscle groups. in one or more muscle groups. In addition, it also causes absence of reflexes.

Combined anterior horn and pyramidal pathway syndrome

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

3. Medullary vascular syndromes

Unlike the syndromes characteristic of complete and incomplete spinal cord injuries, in spinal vascular syndromes the origin of the anomaly lies in 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 directly results in the appearance of strokes or transient ischemic accidents.

Medullary venous ischemia syndrome

This type of syndromes are much more infrequent than the previous ones. In addition, tend to affect the lower extremitiesproducing bilateral syndromes or complete transverse syndromes almost always asymmetrically.

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

Spinal cord hemorrhage syndromes

In these syndromes we can differentiate between intramedullary hemorrhage and extramedullary hemorrhage.. Intramedullary hemorrhage is caused by vascular rupture causing spinal pain, paresis and sensory disturbances below the level of the lesion.

Extramedullary hemorrhage is much rarer. In this case the person experiences acute spinal pain at the site of the effusion, together with symptoms similar to those of a cerebral subarachnoid hemorrhage. These include numbness in one part of the body, seizures, neck tension, vision problems, nausea or muscle aches.