Inside the human body is the spinal cord, a spinal cord that is responsible for transporting nerve impulses from the brain to the rest of the body and vice versa. Thanks to it, we can make any movement, stand up or perceive all kinds of sensations both internal and external.
However, when he is injured or suffers from some kind of pathology they appear medullary syndromes or myelopathies. The term spinal cord syndromes encompasses a variety of disorders of the spinal cord with consequences that affect both motor skills and sensory abilities.
What Are Spinal Cord Syndromes?
Spinal cord syndromes or diseases of the spinal cord a diverse set of symptoms and signs that can vary depending on the location of the spinal cord injury.
Although these conditions usually do not occur very often, they tend to have serious effects and consequences on a person’s health, leading, in many cases, to some form of disability.
This is why an early diagnosis of these spinal syndromes, as well as an effective therapeutic intervention, is essential to reduce or best compensate for the symptoms of these conditions.
We can distinguish several types of spinal cord syndromes depending on the symptoms that each one presents. These symptoms are associated with specific etiological processes; that is, the causes that caused the damage or injury. This damage can affect the entire spinal cord or, conversely, damage only part of the spinal cord in its cross section.
When the healthcare professional needs to diagnose one of these spinal cord syndromes, he or she should consider the possibility that it is one of the conditions, such as certain autoimmune, muscle or psychiatric conditions. , who have similar symptoms. A thorough differential diagnosis will be the key to be able to carry it out satisfactory treatment of the patient.
Types of spinal cord syndromes
As mentioned above, there is a wide variety of classic spinal cord syndromes. The main way to classify them is to take into account their symptoms as well as their temporal pattern.
1. Complete injury of the spinal cord
In cases of complete spinal cord injury or transverse myelopathy, the person will experience the disappearance of all sensory modalities, As well as bilateral impairment of the motor pathways under the lesion.
This syndrome is characterized by sensory and motor symptoms. The sensory symptoms of a complete spinal cord injury are:
- Paresthesia or abnormal tingling sensations and changes in body temperature. These sensations are given in the section corresponding to the level of the lesion.
- Pain localized in the vertebrae.
- Root pain depending on the location of the lesions. If it is a neck injury, the person will feel pain in the arms, while if it is chest or lumbar, the pain will be concentrated in the chest and abdomen or legs.
- Sensitive threshold below or the loss of all sensory modalities.
On the other hand, symptoms related to motor functions include:
- Injuries to lower motor neurons they cause muscle atrophy, fasciculations, or small muscle contractions which can be observed under the skin and hyporeflexia or decreased reflex response.
- Paraparesis / paraplegia or tetraparesis / quadriplegia. The person has problems with paralysis or mobility, both to varying degrees, in the lower limbs or in all four limbs.
2. Incomplete spinal cord injury
In case of syndromes or incomplete spinal cord injuries, the spinal cord is not completely damaged transversely, So that the person does not experience total paralysis or total loss of feeling.
Likewise, there are several types of incomplete spinal cord injuries that differ depending on the set of symptoms they cause.
Spinal cord hemisection Brown-Séquard syndrome
In this case, the person suffers an alteration or lesion of the hemimedule. However, it is very difficult for this injury to occur just in the midline of the spinal cord or to appear purely one-sided.
The hemi-section of the spinal cord can be caused by some type of infection or by an injury at that particular point. Likewise, certain tumor bodies or degenerative diseases they can also cause this type of syndrome.
Symptoms of this condition usually appear at the ipsilateral level and below the level of the lesion, the most important being the paralysis of the first ipsilateral motor neuron and the lack of sensitivity to pain and temperature.
Symptoms of hemisection of the spinal cord include:
- Homolateral paralysis.
- Thermoanalgesia or insensitivity to contralateral temperature.
- Muscle weakness and paralysis.
- Loss or decrease in sensitivity and sensory perception.
- Alterations in the perception of posture and position (Proprioceptive system).
In the intramedullary type condition, damage is found in the central gray matter and in the spinothalamic pathways that pass through the central area of the spinal cord. In addition, this lesion can dissipate centrifugally, affecting other anatomical pathways.
Sensitive symptoms include loss of sensitivity to pain and temperature. At the motor level, the person may experience muscle atrophy, fasciculations, muscle weakness and hyporeflexia.
Combined injury of the 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 the Babinski reflex, which is the dorsal extension of the big toe.
At a sensitive level, symptoms include alterations in the proprioceptive system and sensitivity to vibrations.
Isolated injury to the posterior cords
In this case, the damage is only caused to some posterior cords or fibers. This injury causes an alteration of proprioceptive and vibratory sensitivity in the person, as well as ataxia or difficulties in coordinating movements. In addition, the person you may also feel a throbbing pain in the leg and urinary incontinence.
Anterior spine syndrome
Compared with other conditions, only pure motor symptoms of atrophy in the second motor neuron appear in anterior spine syndrome. These symptoms include fasciculations, muscle weakness, hypotonia and hyporeflexia in one or more muscle groups. In addition, it also causes an absence of reflexes.
Combined pyramidal and anterior horn syndrome
In the latter syndrome of incomplete nature of the spinal cord, also only motor symptoms appear; except that the symptoms of the first and second motor neurons develop simultaneously in the same muscle group. The cause is an abnormality present in the pyramidal tracts and in the anterior stems.
3. Vascular syndromes of the spinal cord
Unlike complete and incomplete spinal cord injury syndromes, in medullary vascular syndromes, the origin of the anomaly is an abnormal blood flow to any area of the spinal cord.
Spinal arterial ischemia syndromes
In this case suspension of arterial blood flow in the spinal cord has as a direct consequence the appearance of cerebrovascular accidents or transient ischemic attacks.
Medullary ischemia syndrome
These types of syndromes are much more common than the previous ones. Outraged, they tend to affect the lower limbs, Producing bilateral syndromes or complete transverse syndromes almost always asymmetrically.
The main causes of this type of pathology are arteriovenous malformations, fibrocartilaginous emboli and the effects of decompression.
Spinal cord hemorrhage syndromes
In these syndromes you can tell the difference between intramedullary hemorrhage and extramedullary hemorrhage. The intramedullary is caused by a vascular rupture causing spinal pain, paresis and sensory alterations below the level of the lesion.
As for extramedullary hemorrhage, it is much rarer. In this case, the person experiences sharp spinal pain at the site of the spill, associated with symptoms similar to those of a subarachnoid brain hemorrhage. These include numbness in any part of the body, seizures, tension in the neck, vision problems, nausea, or muscle pain.