Spinal cord and root compression neurological effects

LATERAL COMPRESSIVE LESION

Corticospinal tract \

Dorsal columns - gracile and cuneate nuclei

Corticospinal tract \

Lateral spinothalamic tract

BROWN

SÉQUARD

SYNDROME

Contralateral impairment of pain and temperature sensation

Contralateral impairment of pain and temperature sensation

Ipsilateral root/segmental signs

Ipsilateral pyramidal weakness and impaired joint position sense and accurate touch localisation

Root/segmental damage muscle weakness in groups supplied by the involved root and segment with lower motor neuron (l.m.n.) signs: - wasting; - loss of tone;

- fasciculation; - diminished or absent reflexes. n.b. motor deficit is seldom detected with root lesions above C5 and from T2 to LI.

sensory defect of all modalities or hyperaesthesia in area supplied by the root, but overlap from adjacent roots may prevent detection.

Long tract - signs and symptoms Partial (Unilateral) cord lesion (Brown-Sequard syndrome)

motor deficit - dragging of the leg. In high cervical lesions weakness of finger movements is noted on the side of the lesion. upper motor neuron (u.m.n.) signs (maximal on side of lesion):

- weakness in a 'pyramidal' distribution, i.e. arms - extensors predominantly affected; legs - flexors predominantly affected.

- increased tone, clonus; - increased reflexes;

- extensor plantar response.

sensory deficit - numbness may occur on the same side as the lesion and a burning dysaesthesia on the opposite side.

- joint position sense and accurate touch localisation (two point discrimination) impaired on side of lesion.

- pinprick and temperature sensation impaired on opposite side.

In practice, cord damage is seldom restricted to one side. Usually a mixed picture occurs, with an asymmetric distribution of signs and symptoms.

Damage to sympathetic pathways in the T1 root or cervical cord causes an ipsilateral Horner's syndrome (page 141).

bladder symptoms are infrequent and only occur when cord damage is bilateral. Precipitancy or difficulty in starting micturition may precede retention.

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