Symptoms of spinal cord injury

Symptoms of focal lesions of the spinal cord are very variable and depend on the prevalence of the pathological process of the genuine and transverse axis of the spinal cord.

Syndromes of lesions of separate sections of the transverse section of the spinal cord. The anterior horn syndrome is characterized by peripheral paralysis with atrophy of muscles innervated by damaged motor neurons of the corresponding segment - segmental or myotomic paralysis (paresis). Often, they are observed fascicular twitchings. Above and below the focus, the muscles remain unaffected. Knowledge of segmental innervation of the muscles allows you to accurately localize the level of damage to the spinal cord. Approximately with the defeat of the cervical thickening of the spinal cord, upper limbs suffer, and the lower limbs suffer from the lower extremities. The efferent part of the reflex arc is interrupted, and deep reflexes fall out. Selectively the anterior horns are affected by neuroviral and vascular diseases.

The syndrome of the horn is manifested by dissociated sensitivity disorder (reduction in pain and temperature sensitivity with joint-muscle, tactile and vibration sensitivity) on the side of the lesion in the area of its dermatome (segmental type of sensitivity disorder). The afferent part of the reflex arc is interrupted, so deep reflexes fade away. This syndrome usually occurs with syringomyelia.

The syndrome of the anterior gray spike is characterized by a symmetrical bilateral pain and temperature sensitivity disorder with joint-muscle, tactile and vibrational sensitivity preserved (dissociated anesthesia) with segmental distribution. The arc of the deep reflex is not disturbed, the reflexes are preserved.

The syndrome of the lateral horn is manifested by vasomotor and trophic disorders in the zone of vegetative innervation. With lesions at the CV-T level, Claude Bernard-Horner syndrome develops on the homolateral side.

Thus, in order to defeat the gray matter of the spinal cord, it is characteristic to turn off the function of one or several segments. Cells located above and below the foci, continue to function.

In another way, the white matter is affected, which is a collection of individual fiber bundles. These fibers are axons of nerve cells located at a considerable distance from the body of the cell. If such a bundle of fibers is damaged, even at a small length along the length and width measured in millimeters, the impending function disorder covers a significant area of the body.

The syndrome of the posterior cord is characterized by loss of joint-muscle feeling, a partial decrease in tactile and vibration sensitivity, the appearance of a sensitive ataxia and paresthesia on the side of the focus below the lesion level (in case of a thin fascicle lesion, these disorders are detected in the lower extremity, the wedge-shaped bundle in the upper). Such a syndrome occurs in syphilis of the nervous system, funicular myelosis, etc.

Side lap syndrome - spastic paralysis on the homolateral focal side, loss of pain and temperature sensitivity on the opposite side by two or three segments below the lesion. With bilateral damage to the lateral cord, spastic paraplegia or tetraplegia develop, dissociated conduction paranesthesia, disruption of the central function of the pelvic organs (urinary retention, feces).

The syndrome of the defeat of half the width of the spinal cord (Brown-Sekar syndrome) is as follows. On the side of the lesion, central paralysis develops and a deeper sensation (defeat of the pyramidal tract in the side cord and fine and wedge-shaped bundles in the posterior) occurs; Disorder of all kinds of sensitivity by segment type; peripheral paresis of the muscles of the corresponding myotome; vegetative-trophic disorders on the side of the focus; conductor dissociated anesthesia on the opposite side (destruction of the spinal-thalamic bundle in the lateral cord) by two or three segments below the lesion. Braun-Secar syndrome occurs with partial injuries of the spinal cord, extramedullary tumors, and occasionally with ischemic spinal strokes (circulatory disturbance in the Sulko-commissural artery, which supplies one half of the transverse section of the spinal cord, the back cord remains unaffected - ischemic Brown-Sekar syndrome).

The defeat of the ventral half of the diameter of the spinal cord is characterized by paralysis of the lower or upper extremities, conductor dissociated paranesthesia, impaired function of the pelvic organs. This syndrome usually develops with ischemic plucking stroke in the basin of the anterior spinal artery (Preobrazhensky's syndrome).

Syndrome of complete defeat of the spinal cord is characterized by spastic lower paraplegia or tetraplegia, peripheral paralysis of the corresponding myotome, paranesthesia of all species, beginning with a certain dermatome and below, impaired pelvic organs function, vegetative-trophic disorders.

Syndromes of lesion along the long axis of the spinal cord. Let's consider the basic variants of syndromes of a lesion on a long axis of a spinal cord, meaning full transversal defeat in each case.

The syndrome of the defeat of the upper cervical segments (C-CV): spasmodic tetraplegia of the sternocleidomastoid, trapezius muscles (X pair) and diaphragm, loss of all kinds of sensitivity below the level of lesion, violation of urination and defecation in the central type; when the CI segment breaks, dissociated anesthesia on the face in the posterior dermatomes of the Selder (deactivation of the lower parts of the trigeminal nerve core) is revealed.

Cervical thickening syndrome (CVT): peripheral paralysis of the upper extremities and spastic - lower extremities, loss of all sensitivities from the level of the affected segment, disorder of the pelvic organs in the central type, bilateral syndrome of Claude Bernard-Horner (ptosis, miosis, enophthalmus) .

Thoracic segment syndrome (T-TX): spastic lower paraplegia, loss of all kinds of sensitivity below the level of lesion, central disorder of pelvic organs, pronounced vegetative-trophic disorders in the lower half of the trunk and lower limbs.

Syndrome of lesion of lumbar thickening (L-S): sluggish lower paraplegia, paranesthesia on lower extremities and in the perineal region, central disorder of pelvic organs.

Syndrome of defeat of segments of the epiconus of the spinal cord (LV-S): symmetrical peripheral paralysis of myotomes LV-S (muscles of the posterior thigh group, leg muscles, foot and gluteus muscles with prolapse of achilles reflexes); paraanesthesia of all kinds of sensitivity on the legs, feet, buttocks and perineum, retention of urine and feces.

Syndrome of damage to segments of the cone of the spinal cord: anesthesia in the anogenital zone ("saddle" anesthesia), loss of anal reflex, disorder of pelvic organs in peripheral type (urinary incontinence, feces), trophic disorders in the sacral region.

Thus, with the defeat of the entire diameter of the spinal cord at any level, the criteria for topical diagnosis are the prevalence of spastic paralysis (lower paraplegia or tetraplegia), the upper limit of sensitivity disturbance (pain, temperature). Especially informative (in the diagnostic plan) the presence of segmental disorders of movement (flaccid muscle paresis, part of the myotome, segmental anesthesia, segmental autonomic disorders). The lower boundary of the pathological focus in the spinal cord is determined by the state of the function of the segmental apparatus of the spinal cord (the presence of deep reflexes, the state of muscle trophism and vegetative-vascular support, the level of inducing symptoms of spinal automatism, etc.).

The combination of a partial lesion of the spinal cord along the transverse and long axes at different levels is often found in clinical practice. Let's consider the most characteristic variants.

The syndrome of involvement of one half of the transverse section of the CI segment: subbulb alternating hemianalgesia, or Opalsky syndrome, - reduction of pain and temperature sensitivity on the face, Claude Bernard-Horner symptom, paresis of limbs and ataxia on the side of the focus; alternating pain and temperature hypsesia on the trunk and extremities opposite to the foci of the side; occurs when the branches of the posterior cerebrospinal artery are blocked, as well as during the neoplastic process at the level of the craniospinal transition.

The syndrome of the defeat of one half of the diameter of the segments of CV-ThI (the combination of Claude Bernard-Horner and Brown-Sekar syndromes): Claude Bernard-Horner syndrome (ptosis, miosis, enophthalmus) on the side of the focus, increasing skin temperature on the face, neck, upper limb and the upper part of the chest, spastic paralysis of the lower limb, loss of joint-muscle, vibration and tactile sensitivity on the lower limb; contralateral-conductive anesthesia (loss of pain and temperature sensitivity) with an upper border on ThII-III dermatome.

Syndrome of involvement of the ventral half of the lumbar thickening (Stanilovsky-Tanon syndrome): lower flaccid paraplegia, dissociated paranesthesia (loss of pain and temperature sensitivity) with the upper border on the lumbar dermatomes (LI-LIII), dysfunction of the pelvic organs of the central type: vegetative-vascular disorders lower limbs; this symptom-complex develops with thrombosis of the anterior spinal artery or its forming a large radiculomedullar artery (arteria Adamkiewicz) at the level of lumbar thickening.

Inverted Brown-Sekar syndrome is characterized by a combination of a spastic paresis of one lower limb (on the same side) and a dissociated sensitivity disorder (loss of pain and temperature) of segmental-conductor type; such a disorder occurs in small-focal lesions of the right and left halves of the spinal cord, as well as in the violation of venous circulation in the lower half of the spinal cord when the major radicular vein is injured in the lumbar intervertebral disk (discogenic venous myelo-ischemia).

The syndrome of the lesion of the dorsal part of the transverse section of the spinal cord (Williamson's syndrome) usually occurs with lesions at the level of the thoracic segments: a violation of the joint-muscular sense and sensitized ataxia in the lower extremities, moderate lower spastic paraparesis with Babinsky's symptom; possible hypesthesia in the corresponding dermatomes, mild violations of the function of the pelvic organs; the syndrome is described in thrombosis of the posterior spinal artery and is associated with ischemia of the posterior cord and partially pyramidal tracts in the lateral cords; at the level of the cervical segments occasionally there is an isolated lesion of the wedge-shaped fascicle with a violation of deep sensitivity in the upper limb on the side of the focus.

Syndrome of amyotrophic lateral sclerosis (ALS): characterized by a gradual development of mixed muscle paresis - muscle strength decreases, muscle is hypotrophic, fascicular twitchings appear, and deep reflexes with pathological signs increase; occurs in the defeat of peripheral and central motoneurons, most often at the level of the medulla oblongata (bulbar variant of amyotrophic lateral sclerosis), cervical (cervical variant of amyotrophic lateral sclerosis) or lumbar thickening (lumbar variant of amyotrophic lateral sclerosis); can be viral, ischemic or dismetabolic in nature.

When the spinal cord, the anterior spine and the anterior horn of the spinal cord are affected, the function of the same muscles constituting the myotome is disrupted. With topical diagnosis within these structures of the nervous system, the combination of myotectomy paralysis with sensitive disorders is taken into account. If there is a localization of the process in the anterior horn or along the course of the anterior spine, there is no disturbance of sensitivity. Only dull indistinct pain in the muscles of the sympathetic nature is possible. The defeat of the spinal nerve leads to paralysis of the myotome and attachment of a violation of all kinds of sensitivity in the corresponding dermatome, as well as the appearance of pain of the radicular nature. The zone of anesthesia is usually smaller than the entire dermatome due to the overlap of sensitive innervation zones with adjacent posterior roots.

The most common syndromes are the following.

The syndrome of damage to the anterior spine of the spinal cord is characterized by peripheral paralysis of the muscles of the corresponding myotome; with it, moderate blunt pain in the tertiary muscles (sympathetic myalgia) is possible.

The syndrome of the lesion of the spine's back root is manifested by intense shooting (pains in the zone of the dermatome, lancinating like "passing an electric current pulse"), all kinds of sensitivity in the dermatome zone are violated, deep and surface reflexes are falling or disappearing, the point of the spine outlet from the intervertebral foramen becomes painful, positive symptoms of the tension of the root are revealed.

The syndrome of the spinal cord injury includes the symptoms of the lesion of the anterior and posterior spinal roots, that is, there is a paresis of the corresponding myotome and a violation of all kinds of sensitivity along the root type.

The syndrome of damage to the root of the horse tail (L-SV) is characterized by severe root pain and anesthesia in the lower limbs, sacrum and gluteal regions, the perineal region; peripheral paralysis of the lower limbs with the extinction of the knee, achilles and plantar reflexes, a violation of the pelvic organs with true incontinence of urine and feces, impotence. With tumors (neurinomas) of the roots of the horse tail, the pain in the vertical position of the patient is exacerbated (the symptom of the radicular pain of the position is the Dandy-Razdolsky symptom).

Differential diagnosis of intra- or extramedullary lesions is determined by the nature of the developmental process of neurological disorders (descending or ascending type of disorder).

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