Complete spinal cord lesion (r/o spinal shock)

• Total loss of motor and sensation distal to the site that persists for longer than 24 hours after injury
• Any sacral sparing (peri-anal sensation) indicates a more possible positive prognosis
• May be mimicked spinal shock - concussive injury to spinal cord lasting up to several days

Incomplete spinal cord lesions

• Central cord syndrome
• Brown-Séquard syndrome
• Anterior cord syndrome
• Posteroinferior cerebellar artery syndrome
• Horner's syndrome
• Cauda equina
• SCIWORA

Central Cord

• Most common incomplete spinal cord syndrome
• Central cord damage to corticospinal and spinothalamic tracts
• Distal innervation is more lateral on the cord and proximal innveration is more central on the cord - leads to more proximal than distal deficits
• Decreased strength, pain, temperature more in the upper than the lower extremities
• Dance but can't play piano
• Most will retain bowel and bladder control
• Caused by hyperextension injuries in older patients with degenerative arthritis or spinal stenosis of cervical vertebrae, extension teardrop fx, vascular injuries

Brown-Séquard syndrome

• Unilateral cord compression/hemisection
• Loss of ipsilateral motor function/proprioception/vibration
• Loss of contralateral pain/temperature
• Caused by penetrating trauma or lateral mass lesions (hematoma, tumor, fx) of the cervical spine

Anterior cord syndrome

• Direct anterior cord compression causing damage to corticospinal and spinothalamic pathways, with preservation of posterior column function
• Loss of motor/pain/temperature distal to the lesion
• Preservation of proprioception and vibratory function
• Caused by hyperflexion of cervical spine, protrusion of a bony fragment (burst fx) or herniated disk into the spinal canal, or damage to anterior spinal artery

Transverse myelitis

• Symptom onset over hours to day
• May be associated with viral like illness

Guillain-Barré Syndrome

Spinal Stroke

• Acute paraparesis or quadriparesis depending on level of injury
• Usually abrupt onset - minutes to hours
• May be associated with pain in neck or back
• Anterior spinal artery
• Most common clinical presentation
• Loss of motor function (could impair respiratory muscles) and pain/temperature sensation and DTR's
• Sparing of proprioception and vibratory sense below the level of the lesion
• Autonomic dysfunction - hypotension, loss of bowel or bladder function
• Posterior spinal artery
• Total anesthesia at the level of the injury
• Loss of proprioception and vibratory sense below the level of the injury
• May have mild or transient weakness
• More likely unilateral