Spinal Cord Syndrome

Aka: Spinal Cord Syndrome, Epidural Spinal Cord Compression, Acute Spinal Cord Compression, Spinal Cord Compression, Partial Cord Syndrome, Quadriplegia, Paraplegia

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II. Definitions

  1. Paraplegia
    1. Complete paralysis of the lower part of the body including the legs
    2. Level of thoracolumbar spine lesion determines deficits
  2. Quadriplegia
    1. Paralysis of all four limbs and trunk
    2. Level of Cervical Spine lesion determines deficits

III. Symptoms

  1. Acute neck or back pain
  2. Extremity weakness or paralysis
  3. Sensory deficits with broader distribution than individual Dermatomes
  4. Changes in bowel or Bladder function (e.g. acute urinary or stool retention or Incontinence)

IV. History

  1. Acute Spinal Trauma
    1. Cervical Spine Injury is most common level of cord injury
  2. Epidural Neoplasm
    1. Thoracic Spine involvement is more common
    2. Review malignancy risk factors
  3. Epidural Abscess Risks
    1. Thoracic Spine involvement is more common
    2. Fever
    3. Immunosuppression
    4. Intravenous Drug Abuse
  4. Spinal Epidural Hematoma Risks
    1. Anticoagulation
    2. Spinal Procedures (e.g. spine surgery)

V. Exam: Distinguishing Upper from Lower Motor Neuron Injury

  1. Upper Motor Neuron Lesion (lesion proximal to the spinal cord anterior horn cells)
    1. Hyperreflexia
    2. Clonus
    3. Motor Spasticity
    4. Increased Muscle tone
    5. Babinski Sign positive
    6. Muscles without atrophy (normal Muscle mass)
  2. Lower Motor Neuron Lesion (lesion distal to the spinal cord anterior horn cells)
    1. Motor Weakness to Flaccid Paralysis
    2. Muscle Atrophy
    3. Muscle Fasciculations
    4. Deep Tendon Reflexes decreased or lost

VI. Types: Spinal Cord Syndrome

  1. Trauma - Complete transection of the spinal cord
    1. Complete Cord Syndrome
  2. Trauma - Partial spinal cord injuries
    1. Anterior Cord Syndrome
    2. Central Cord Syndrome
    3. Spinal Cord Hemisection (Brown-Sequard Syndrome, rare)
    4. Neuropraxia (Stinger, Burner)
  3. Other cord syndromes
    1. Spinal Shock
    2. Cauda Equina Syndrome
    3. Conus Medullaris Syndrome
      1. Similar to Cauda Equina, but with compression at L1-L2 and sensory deficits at Lumbosacral Spine
  4. Images
    1. CordSyndrome.jpg

VII. Causes

  1. Traumatic Spinal Injury
  2. Epidural Neoplasm
  3. Spinal Epidural Abscess
  4. Spinal Epidural Hematoma

VIII. Differential Diagnosis

  1. See Peripheral Neuropathy
  2. See Cervical Spinal Stenosis
  3. See Lumbar Spinal Stenosis
  4. See Claudication

IX. Imaging

  1. CT Spine
    1. First-Line study in Spine Trauma
  2. MRI Spine
    1. Indicated in suspected Epidural Neoplasm, Spinal Epidural Abscess, Epidural Abscess or cord syndrome

X. Management

  1. See Spinal Trauma
  2. See Epidural Neoplasm
  3. See Spinal Epidural Abscess
  4. See Spinal Epidural Hematoma

XI. References

  1. Dasburg (2020) Crit Dec Emerg Med 34(6): 28-9
  2. Decker in Chorley and Bachur (2014) Overview of Cervical Spinal Cord Injuries..., UpToDate, Wolters-Kluwer
  3. Wagner (1997) Emerg Med Clin North Am 15:699-711 [PubMed]

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Related Studies

Ontology: Paraplegia (C0030486)

Definition (CHV) complete or partial loss of movement in the lower part of the body, including both legs
Definition (CHV) complete or partial loss of movement in the lower part of the body, including both legs
Definition (NCI_FDA) Paralysis of the legs and lower part of the body.
Definition (NCI) Complete paralysis of the lower half of the body including both legs, often caused by damage to the spinal cord.
Definition (MSH) Severe or complete loss of motor function in the lower extremities and lower portions of the trunk. This condition is most often associated with SPINAL CORD DISEASES, although BRAIN DISEASES; PERIPHERAL NERVOUS SYSTEM DISEASES; NEUROMUSCULAR DISEASES; and MUSCULAR DISEASES may also cause bilateral leg weakness.
Definition (PSY) Paralysis of the lower limbs and trunk.
Definition (CSP) severe or complete loss of motor function in the lower extremities and lower portions of the trunk.
Concepts Disease or Syndrome (T047)
MSH D010264
ICD9 344.1
ICD10 G82.2 , G82.20
SnomedCT 155031004, 60389000
LNC MTHU020806
English Paraplegia, Paraplegias, Paraplegia, unspecified, paralysis in both legs (physical finding), paralysis in both legs, paralysis was seen in both legs, Leg paralysis, Paralysis leg, Paralysis, Lower Extremities, Paralysis, Legs, Paralysis, Lower Limbs, leg paralysis, Paraplegia NOS, paralysis of leg (symptom), paralysis of leg, Paralysis of both lower limbs NOS, Paraplegia (lower) NOS, Paraplegia [Disease/Finding], paraplegia, extremities lower paralysis, Paralysis legs, Paraplegia (complete or partial paralysis of legs), Hindlimb paralysis, PARAPLEGIA, Lower paraplegia, Paralysis of both lower limbs, Paraplegia (disorder), leg; paralysis, both, leg; paralysis, paralysis; leg, both, paralysis; leg, Paraplegia, lower
French PARAPLEGIE, Paralysie de la jambe, Paralysie des jambes, Paraplégie
Portuguese PARAPLEGIA, Paralisia da perna, Paralisia das pernas, Paraplegia, Paralisia da Extremidades Inferiores
Spanish PARAPLEJIA, Parálisis de piernas, Paralisis de pierna, Parálisis de pierna, Paraplejía, paraplejía (trastorno), paraplejía inferior, paraplejía, parálisis de ambas extremidades inferiores, parálisis de ambos miembros inferiores, Paraplejia, Parálisis de las Extremidades Inferiores
Dutch beenparalyse, paralyse benen, paralyse been, been; paralyse, beide, been; paralyse, paralyse; been, beide, paralyse; been, Paraplegie, niet gespecificeerd, paraplegie, Paralyse, onderste extremiteiten, Paraplegie
German Beinlaehmung, Laehmung der Beine, Laehmung Bein, Paraplegie, nicht naeher bezeichnet, QUERSCHNITTSLAEHMUNG, Querschnittslaehmung, Paraplegie, Lähmung, untere Extremitäten, Paralyse, untere Extremitäten
Italian Paralisi della gamba, Paralisi delle gambe, Paralisi degli arti inferiori, Paralisi delle basse estremità, Paraplegia
Japanese 下肢麻痺, 両下肢麻痺, ｶｼﾏﾋ, ﾘｮｳｶｼﾏﾋ, ﾂｲﾏﾋ, パラプレジア, 両側麻痺, 痙性両麻痺, 両麻痺, 痙性対麻痺, 対麻痺
Swedish Förlamning, dubbelsidig
Czech paraplegie, Ochrnutí dolní končetiny, Paraplegie, Ochrnutí nohou
Finnish Paraplegia
Russian SPASTICHESKAIA PARAPLEGIIA NIZHNIKH KONECHNOSTEI, PARAPLEGIIA, PARALICH SPASTICHESKII NIZHNIKH KONECHNOSTEI, ПАРАЛИЧ СПАСТИЧЕСКИЙ НИЖНИХ КОНЕЧНОСТЕЙ, ПАРАПЛЕГИЯ, СПАСТИЧЕСКАЯ ПАРАПЛЕГИЯ НИЖНИХ КОНЕЧНОСТЕЙ
Korean 상세불명의 대마비
Croatian PARAPLEGIJA
Polish Porażenie kończyn dolnych, Paraplegia
Hungarian Paralysis, lábak, Paraplegia, Paralysis, láb, Láb paralysis
Norwegian Paralyse av underekstremitetene, Paraplegi, Underekstremitetslammelse
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Quadriplegia (C0034372)

Definition (NCI) Paralysis of all four limbs.
Definition (NCI_FDA) Paralysis of all four limbs.
Definition (MSH) Severe or complete loss of motor function in all four limbs which may result from BRAIN DISEASES; SPINAL CORD DISEASES; PERIPHERAL NERVOUS SYSTEM DISEASES; NEUROMUSCULAR DISEASES; or rarely MUSCULAR DISEASES. The locked-in syndrome is characterized by quadriplegia in combination with cranial muscle paralysis. Consciousness is spared and the only retained voluntary motor activity may be limited eye movements. This condition is usually caused by a lesion in the upper BRAIN STEM which injures the descending cortico-spinal and cortico-bulbar tracts.
Definition (PSY) Paralysis of both arms and both legs.
Concepts Disease or Syndrome (T047)
MSH D011782
ICD9 344.00
ICD10 G82.5 , G82.50
SnomedCT 11538006, 155030003
LNC MTHU020808
English Quadriplegias, Tetraplegia, Tetraplegias, TETRAPLEGIA, Quadraplegia, Quadriplegia, unspecified, Tetraplegia, unspecified, quadriplegia, quadriplegia (physical finding), quadriplegia was seen, Quadriplegia, unspecifd, Quadriplegia [Disease/Finding], quadraplegia, QUADRIPLEGIA, Quadriplegia (disorder), tetraplegia, limb; paralysis, all four, paralysis; limb, all four, Quadriplegia, QuaDriplegia
French QUADRIPLEGIE, TETRAPLEGIE, Quadriplégie, non précisée, Quadriplégie, Tétraplégie
German QUADRIPLEGIE, Quadriplegie, unspezifisch, TETRAPLEGIE, Tetraplegie, nicht naeher bezeichnet, Quadriplegie, Tetraplegie
Portuguese TETRAPLEGIA, Quadriplegia NE, Tetraplegia, Quadriplegia
Spanish TETRAPLEJIA, Tetraplejia no especificada, Cuadriplejia, Tetraplejía, Cuadriplejía, CUADRIPLEJIA, cuadriplejía (trastorno), cuadriplejía, tetraplejía, Tetraplejia
Dutch quadriplegie, niet-gespecificeerd, tetraplegie, extremiteit; paralyse, alle vier, paralyse; extremiteit, alle vier, Tetraplegie, niet gespecificeerd, quadriplegie, Quadriplegie, Tetraplegie
Italian Tetraplegia, non specificata, Tetraplegia, Quadriplegia
Japanese 四肢麻痺、詳細不明, ｼｼﾏﾋ, ｼｼﾏﾋｼｮｳｻｲﾌﾒｲ, 四肢麻痺
Swedish Tetraplegi
Czech kvadruplegie, tetraplegie, Tetraplegie, Kvadruplegie, Kvadruplegie, blíže neurčená
Finnish Tetraplegia
Russian SINDROM LOCKED-IN, TETRAPLEGIIA, LOCKED-IN SINDROM, KVADRIPLEGIIA, LOCKED-IN СИНДРОМ, КВАДРИПЛЕГИЯ, СИНДРОМ LOCKED-IN, ТЕТРАПЛЕГИЯ
Korean 상세불명의 사지마비
Croatian KVADRIPLEGIJA
Polish Porażenie czterech kończyn, Tetraplegia, Kwadriplegia, Paraliż czterech kończyn
Hungarian Tetraplegia, Tetraplegia, nem meghatározott
Norwegian Kvadriplegi, Tetraplegi
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Compression of spinal cord (C0037926)

Definition (MSHCZE) Soubor příznaků rozvíjejících se při útlaku míchy z různých příčin (nádory, traumata, aj.), nejč. příčinou je však mediální nebo paramediální protruze a herniace ploténky krční páteře. Komprese míchy je přímá a též v důsledku alterace krevního oběhu postižené oblasti. Při alteraci kortikospinálních drah se rozvíjí slabá centrální paraparéza dolních končetin, při lézi předních rohů míšních dojde k periferní obrně příslušných svalových skupin horních končetin. V klinickém obraze často dominují vegetativní a vazomotorické poruchy (např. edémy akrálních částí končetin s lividním zabarvením kůže). Prognóza a průběh závisejí na vyvolávající příčině. (cit. Velký lékařský slovník online, 2013 http://lekarske.slovniky.cz/ )
Definition (MSH) Acute and chronic conditions characterized by external mechanical compression of the SPINAL CORD due to extramedullary neoplasm; EPIDURAL ABSCESS; SPINAL FRACTURES; bony deformities of the vertebral bodies; and other conditions. Clinical manifestations vary with the anatomic site of the lesion and may include localized pain, weakness, sensory loss, incontinence, and impotence.
Concepts Disease or Syndrome (T047)
MSH D013117
ICD10 G95.2 , G95.20
SnomedCT 71286001, 282807009, 192913003, 193080004, 230140007, 230141006
English Compressions, Spinal Cord, Spinal Cord Compression, Spinal Cord Compressions, Compression, Spinal Cord, SPINAL CORD COMPRESSION, Cord compression, Spinal cord compression NOS, Cord compression, unspecified, Compression of spinal cord, Cord compression, NOS, spinal cord compression (diagnosis), spinal cord compression, Extramedullary Spinal Cord Compression, Spinal Cord Compression, Extramedullary, Compressive Myelopathy, Myelopathy, Compressive, Unspecified cord compression, Spinal Cord Compression [Disease/Finding], cord compression, Compression;spinal cord, spinal cord compressions, compression spinal cord, compressive myelopathy, compression cord spinal, compression of spinal cord, (Cord compression) or (spinal cord compression) (disorder), Spinal cord compression NOS (disorder), Cord compression NOS (disorder), (Cord compression) or (spinal cord compression), Spinal cord compression, SCC - Spinal cord compression, Spinal cord compression (disorder), compression; spinal cord, spinal cord; compression, Spinal cord compression, NOS, Cord compression NOS
French COMPRESSION MOELLE EPINIERE, Compression de la moelle épinière SAI, Compression de la moelle épinière, Compression de la moëlle épinière, Compression médullaire, Syndrome de compression médullaire
Dutch ruggenmergcompressie NAO, compressie; ruggenmerg, ruggenmerg; compressie, Compressie van ruggenmerg, niet gespecificeerd, ruggenmerg compressie, Compressie, ruggenmerg-, Myelopathie, compressieve, Ruggenmergcompressie
German Rueckenmarkskompression NNB, Rueckenmarkkompression, nicht naeher bezeichnet, Rueckenmarkskompression, Myelopathie, kompressive, Kompression, Rückenmark-, Rückenmarkkompression
Italian Compressione del midollo spinale NAS, Compressione del midollo spinale da causa extramidollare, Mielopatia compressiva, Compressione del midollo spinale
Portuguese Compressão da medula spinal NE, Compressão da Medula Espinal, COMPRESSAO MEDULAR, Compressão da Medula Espinhal, Compressão da espinal-medula, Mielopatia Compressiva
Spanish Compresión de la médula espinal NEOM, compresión medular, SAI (trastorno), compresión medular, SAI, compresión de la médula espinal, SAI, compresión de la médula espinal, SAI (trastorno), compresión de la médula espinal (trastorno), compresión de la médula espinal, Compresión de la médula espinal, Compresión de la Médula Espinal, Mielopatía Compresiva
Japanese 脊髄圧迫ＮＯＳ, ｾｷｽﾞｲｱｯﾊﾟｸ, ｾｷｽﾞｲｱｯﾊﾟｸNOS, 脊髄圧迫
Swedish Ryggmärgskompression
Finnish Selkäytimen puristustila
Russian MOZGA SPINNOGO SDAVLENIE, МОЗГА СПИННОГО СДАВЛЕНИЕ
Czech Komprese míchy NOS, Komprese míchy, kompresivní myelopatie, komprese míchy, mícha - komprese, syndrom komprese míchy
Korean 상세불명의 척수압박
Polish Ucisk rdzenia kręgowego, Ciasnota kanału kręgowego
Hungarian Gerincvelő compressio k.m.n., Gerincvelő compressio
Norwegian Kompresjonsmyelopati, Ryggmargskompresjon, Ekstramedullær ryggmargskompresjon
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Spinal cord syndrome (C0560648)

Concepts Injury or Poisoning (T037)
SnomedCT 282784007
English spinal cord syndrome, cord spinal syndrome, cord spinal syndromes, Spinal cord syndrome, spinal cord syndrome (diagnosis), Spinal cord syndrome (disorder)
Spanish síndrome de médula espinal (trastorno), síndrome de médula espinal
Derived from the NIH UMLS (Unified Medical Language System)

Related Topics in Cervical Spine Disorders

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