Within the human body is the spinal cord, an extensive cord that is responsible for transport nerve impulses from the brain to the rest of the body and vice versa Thanks to it we can make any movement, stand or perceive all kinds of sensations, both internal and external.
However, when it is injured or suffers some type of pathology spinal syndromes or myelopathies appear The term spinal syndromes groups together a variety of conditions of the spinal cord with consequences that affect both motor skills and sensory abilities.
Spinal cord 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 injury
Although these conditions do not usually occur very frequently, they tend to cause serious effects and consequences on the person’s health, leading, in many cases, to some type of disability
This is the reason why a hasty diagnosis of these spinal syndromes, as well as an effective therapeutic intervention, is essential to reduce or compensate in the best way for the symptoms of these conditions.
We can distinguish several types of spinal syndromes based on the symptoms that each of them present. These symptoms are associated with specific etiological processes; that is, to the causes that caused the damage or injury. These damages can affect the entire spinal cylinder or, on the contrary, damage only a part of the spinal cord in its transverse section.
When the medical professional has to make a diagnosis of one of these spinal syndromes, he must take into account the possibility that it may be one of the conditions, such as some autoimmune, muscular or psychiatric diseases, which have specific symptoms. similar. An exhaustive differential diagnosis will be the key to being able to carry out satisfactory patient treatment
As mentioned above, there is a wide variety of classic spinal cord syndromes. The main way to classify them is taking into account their symptoms, as well as their temporal pattern.
1. Complete spinal cord injury
In 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 motor pathways that are below the injury.
This syndrome is characterized by presenting sensory symptoms and motor symptoms. The sensory symptoms of a complete spinal cord injury are:
On the other hand, symptoms related to motor functions include:
2. Incomplete spinal cord injury
In cases of incomplete spinal cord syndromes or lesions, the spinal cord is not completely damaged at the transverse level so the person does not experience either total paralysis or a total loss of sensitivity.
Likewise, there are several types of incomplete spinal cord injuries that differ depending on the set of symptoms they cause.
Spinal hemisection or Brown-Séquard syndrome
In this case the person suffers an alteration or damage to the hemimedulla However, it is very difficult for this lesion to occur right in the midline of the spinal cord or for it to appear purely unilaterally.
Spinal hemisection can be caused by some type of infection or by an injury to that specific point. In addition, certain tumor bodies or degenerative diseases They can also cause this type of syndrome.
The symptoms of this condition usually appear ipsilaterally and below the level of the lesion, the most important being the paralysis of the ipsilateral first motor neuron and the lack of sensitivity to pain and temperature.
In the centromedullary type condition, the damage is found in the central gray matter and in the spinothalamic tracts that cross the central area of the spinal cord. Furthermore, this injury can dissipate centrifugally, affecting other anatomical pathways.
Among the sensory symptoms we find a loss of sensitivity to pain and temperature While at a motor level the person may experience muscle atrophy, fasciculations, muscle weakness and hyporeflexia.
Combined posterior and lateral cord injury
In this type of injury the person may experience motor symptoms such as muscle weakness, spasticity or constant muscle contraction, hyperreflexia and Babinski reflex, which consists of dorsal extension of the big toe.
On a sensory level, symptoms include alterations in the proprioceptive system and sensitivity to vibration
Isolated posterior cord injury
In this case the damage is caused only in certain posterior cords or fibers. This injury causes the person to have an alteration in proprioceptive and vibration sensitivity, as well as ataxia or difficulties in coordinating movements. Furthermore, the person You may also experience stabbing pain in your legs and urinary incontinence
Anterior horn syndrome
Compared to the rest of the conditions, in anterior horn syndrome only pure motor symptoms appear, typical of an atrophy in the second motor neuron. 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 tract and anterior horn syndrome
In this last syndrome of incomplete spinal cord nature, also only motor symptoms appear ; with the difference that symptoms of the first and second motor neurons develop simultaneously within the same muscle group. The cause is an anomaly present in the pyramidal tracts and anterior horns.
Unlike the syndromes of complete and incomplete spinal cord injuries, in spinal vascular syndromes the origin of the anomaly is found in an abnormality of blood flow in any area of the spinal cord
Medullary arterial ischemia syndromes
In this case, the suspension of arterial blood flow to the spinal cord directly results in the appearance of strokes or transient ischemic attacks.
Spinal venous ischemia syndrome
These types of syndromes are much rarer than the previous ones. Besides, tend to affect the lower extremities producing 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 hemorrhage syndromes
In these syndromes we can differentiate between intramedullary hemorrhage and extramedullary hemorrhage Intramedullary is caused by a vascular rupture causing spinal pain, paresis and sensory alterations below the level of the injury.
As for extramedullary hemorrhage, this is much more rare. In this case, the person experiences acute spinal pain at the site where the effusion is located, together with symptoms similar to those of a cerebral subarachnoid hemorrhage. These include numbness in a part of the body, seizures, cervical tension, vision problems, nausea or muscle pain.
