Symptoms of spinal cord injury

Symptoms of focal lesions of the spinal cord are highly variable and depend on the extent of the pathological process along the true and transverse axes of the spinal cord.

Syndromes of damage to individual sections of the spinal cord cross-section. The anterior horn syndrome is characterized by peripheral paralysis with atrophy of the muscles innervated by damaged motor neurons of the corresponding segment - segmental or myotomic paralysis (paresis). Fascicular twitching is often observed in them. The muscles above and below the lesion remain unaffected. Knowledge of the segmental innervation of muscles allows for fairly accurate localization of the level of spinal cord damage. Approximately, with damage to the cervical thickening of the spinal cord, the upper limbs are affected, and with damage to the lumbar thickening, the lower limbs are affected. The efferent part of the reflex arc is interrupted, and deep reflexes are lost. The anterior horns are selectively affected in neuroviral and vascular diseases.

Posterior horn syndrome is manifested by dissociated sensitivity disorder (reduction of pain and temperature sensitivity with preservation of joint-muscular, tactile and vibration sensitivity) on the side of the lesion, in the zone of its dermatome (segmental type of sensitivity disorder). The afferent part of the reflex arc is interrupted, therefore deep reflexes fade. Such syndrome is usually found in syringomyelia.

The syndrome of the anterior gray commissure is characterized by symmetrical bilateral disorder of pain and temperature sensitivity with preservation of joint-muscular, tactile and vibration sensitivity (dissociated anesthesia) with segmental distribution. The arc of the deep reflex is not impaired, reflexes are preserved.

Lateral horn syndrome manifests itself in vasomotor and trophic disorders in the area of autonomic innervation. When the CV-T level is affected, Claude Bernard-Horner syndrome occurs on the homolateral side.

Thus, damage to the gray matter of the spinal cord is characterized by the shutdown of the function of one or more segments. The cells located above and below the lesions continue to function.

The lesions of the white matter, which is a collection of individual bundles of fibers, manifest themselves differently. These fibers are the axons of nerve cells located at a considerable distance from the cell body. If such a bundle of fibers is damaged even over an insignificant distance in length and width, measured in millimeters, the resulting dysfunction covers a significant area of the body.

The posterior cord syndrome is characterized by loss of joint-muscle sense, partial decrease of tactile and vibration sensitivity, appearance of sensory ataxia and paresthesia on the side of the lesion below the level of the lesion (with damage to the thin fascicle, these disorders are found in the lower limb, and the cuneate fascicle - in the upper limb). This syndrome occurs in syphilis of the nervous system, funicular myelosis, etc.

Lateral cord syndrome - spastic paralysis on the side homolateral to the lesion, loss of pain and temperature sensitivity on the opposite side two to three segments below the lesion. With bilateral damage to the lateral cords, spastic paraplegia or tetraplegia, dissociated conduction paraanesthesia, and central pelvic dysfunction (urinary and fecal retention) develop.

The syndrome of damage to half the transverse section of the spinal cord (Brown-Sequard syndrome) is as follows. On the side of the lesion, central paralysis develops and there is a shutdown of deep sensitivity (lesion of the pyramidal tract in the lateral funiculus and thin and cuneate fasciculi in the posterior funiculus); disorder of all types of sensitivity of the segmental type; peripheral paresis of the muscles of the corresponding myotome; vegetative-trophic disorders on the side of the lesion; conduction dissociated anesthesia on the opposite side (destruction of the spinothalamic fasciculus in the lateral funiculus) two or three segments below the lesion. Brown-Sequard syndrome occurs in partial injuries to the spinal cord, extramedullary tumors, and occasionally in ischemic spinal strokes (impaired blood circulation in the sulcocommissural artery supplying one half of the transverse section of the spinal cord; the posterior funiculus remains unaffected - ischemic Brown-Sequard syndrome).

The lesion of the ventral half of the spinal cord transverse is characterized by paralysis of the lower or upper extremities, conductive dissociated paraanesthesia, and dysfunction of the pelvic organs. This syndrome usually develops with ischemic pinching stroke in the basin of the anterior spinal artery (Preobrazhensky syndrome).

The syndrome of complete spinal cord injury is characterized by spastic lower paraplegia or tetraplegia, peripheral paralysis of the corresponding myotome, paraanesthesia of all types, starting from a certain dermatome and below, dysfunction of the pelvic organs, and vegetative-trophic disorders.

Syndromes of damage along the long axis of the spinal cord. Let us consider the main variants of syndromes of damage along the long axis of the spinal cord, keeping in mind the complete transverse damage in each case.

Upper cervical segment lesion syndrome (C-CV): spastic tetraplegia of the sternocleidomastoid, trapezius muscles (X pair) and diaphragm, loss of all types of sensitivity below the level of the lesion, central urination and defecation disorder; with destruction of the CI segment, dissociated anesthesia is detected on the face in the posterior dermatomes of Zelder (disabling the lower parts of the trigeminal nucleus).

Cervical vertebral column syndrome (CV-T): peripheral paralysis of the upper limbs and spastic paralysis of the lower limbs, loss of all types of sensitivity from the level of the affected segment, central pelvic dysfunction, bilateral Claude Bernard-Horner syndrome (ptosis, miosis, enophthalmos).

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

Lumbar thickening syndrome (L-S): flaccid lower paraplegia, paraanesthesia in the lower limbs and perineum, central dysfunction of the pelvic organs.

Spinal cord epiconus segment lesion syndrome (LV-S): symmetrical peripheral paralysis of the LV-S myotomes (muscles of the posterior group of thighs, muscles of the lower leg, foot and gluteal muscles with loss of Achilles reflexes); paraanesthesia of all types of sensitivity in the lower legs, feet, buttocks and perineum, retention of urine and feces.

Syndrome of damage to the segments of the spinal cord conus: anesthesia in the anogenital area ("saddle" anesthesia), loss of anal reflex, dysfunction of the pelvic organs of a peripheral type (urinary and fecal incontinence), trophic disorders in the sacral region.

Thus, in case of damage of the entire spinal cord cross-section at any level, the criteria for topical diagnostics are the prevalence of spastic paralysis (lower paraplegia or tetraplegia), the upper limit of sensitivity disorders (pain, temperature). Particularly informative (in diagnostic terms) is the presence of segmental movement disorders (flaccid paresis of muscles that are part of the myotome, segmental anesthesia, segmental vegetative disorders). The lower limit 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 supply, the level of induction of symptoms of spinal automatism, etc.).

A combination of partial spinal cord damage along the transverse and long axis at different levels is often encountered in clinical practice. Let us consider the most typical variants.

Syndrome of damage to one half of the transverse section of the CI segment: subbulbar alternating hemianalgesia, or Opalski's syndrome - decreased pain and temperature sensitivity on the face, Claude Bernard-Horner symptom, paresis of the limbs and ataxia on the side of the lesion; alternating pain and temperature hypoesthesia on the trunk and limbs on the side opposite the lesion; occurs with blockage of the branches of the posterior spinal artery, as well as with a neoplastic process at the level of the craniospinal junction.

Syndrome of damage to one half of the cross-section of the CV-ThI segments (a combination of Claude Bernard-Horner and Brown-Sequard syndromes): on the side of the lesion - Claude Bernard-Horner syndrome (ptosis, miosis, enophthalmos), increased skin temperature on the face, neck, upper limb and upper chest, spastic paralysis of the lower limb, loss of joint-muscular, vibration and tactile sensitivity in the lower limb; contralateral conduction anesthesia (loss of pain and temperature sensitivity) with the upper border on the ThII-III dermatome.

Syndrome of damage to the ventral half of the lumbar enlargement (Stanilowski-Tanon syndrome): lower flaccid paraplegia, dissociated paraanesthesia (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 of the lower extremities; this symptom complex develops with thrombosis of the anterior spinal artery or its forming large radiculomedullary artery (Adamkiewicz artery) at the level of the lumbar enlargement.

Inverted Brown-Sequard syndrome is characterized by a combination of spastic paresis of one lower limb (on the same side) and dissociated sensory disturbance (loss of pain and temperature) of the segmental-conductive type; such a disorder occurs with small focal lesions of the right and left halves of the spinal cord, as well as with impaired venous circulation in the lower half of the spinal cord with compression of a large radicular vein by a herniated lumbar intervertebral disc (discogenic-venous myeloischemia).

Dorsal transverse section syndrome (Williamson syndrome) usually occurs with lesions at the level of the thoracic segments: impaired joint-muscle sense and sensory ataxia in the lower limbs, moderate lower spastic paraparesis with Babinski's sign; hypoesthesia in the corresponding dermatomes, mild dysfunction of the pelvic organs are possible; the syndrome has been described in thrombosis of the posterior spinal artery and is associated with ischemia of the posterior funiculi and partially of the pyramidal tracts in the lateral funiculi; at the level of the cervical segments, isolated lesions of the wedge-shaped fasciculus with impaired deep sensitivity in the upper limb on the side of the lesion are rare.

Amyotrophic lateral sclerosis syndrome (ALS): characterized by the gradual development of mixed muscle paresis - decreased muscle strength, muscle hypotrophy, fascicular twitching, and increased deep reflexes with pathological signs; occurs with damage to peripheral and central motor neurons, 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 dysmetabolic in nature.

When the spinal nerve, anterior root and anterior horn of the spinal cord are affected, the function of the same muscles that make up the myotome is impaired. In topical diagnostics, a combination of myotome paralysis and sensory disturbances is taken into account within these structures of the nervous system. When the process is localized in the anterior horn or along the anterior root, there are no sensory disturbances. Only dull, indistinct pain in the muscles of a sympathetic nature is possible. Damage to the spinal nerve leads to myotome paralysis and the addition of disturbances of all types of sensitivity in the corresponding dermatome, as well as to the appearance of pain of a radicular nature. The anesthesia zone is usually smaller than the territory of the entire dermatome due to the overlap of sensory innervation zones by adjacent posterior roots.

The most common syndromes are:

Anterior root syndrome is characterized by peripheral paralysis of the muscles of the corresponding myotome; it may cause moderate dull pain in the tertiary muscles (sympathetic myalgia).

The syndrome of damage to the posterior root of the spinal cord is manifested by intense shooting (lance-like, like “passing an electric current impulse”) pain in the dermatome area, all types of sensitivity in the dermatome area are impaired, deep and superficial reflexes are reduced or disappear, the point of exit of the root from the intervertebral foramen becomes painful, positive symptoms of root tension are revealed.

The syndrome of damage to the spinal nerve trunk includes symptoms of damage to the anterior and posterior spinal root, i.e. there is paresis of the corresponding myotome and disturbances of all types of sensitivity of the radicular type.

The syndrome of damage of the roots of the equine tail (L - SV) is characterized by severe radicular pain and anesthesia in the lower limbs, sacral and gluteal regions, perineal region; peripheral paralysis of the lower limbs with fading of the knee, Achilles and plantar reflexes, dysfunction of the pelvic organs with true incontinence of urine and feces, impotence. In case of tumors (neurinomas) of the roots of the equine tail, an exacerbation of pain is observed in the vertical position of the patient (symptom of radicular pain of position - Dendy-Razdolsky symptom).

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

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