FFinalistSouthampton · 2027
Neurology
AKT · Neurology/Cord & peripherallow yield

Spinal cord injury & syndromes

Traumatic/structural cord damage — pattern by tracts involved

Overview

Damage to the spinal cord (trauma, ischaemia) producing characteristic patterns depending on which tracts are involved. The exam tests recognising the syndrome from the dissociation of motor, pain/temperature and dorsal-column (proprioception/vibration) signs.

Recognise

  • Complete: loss of all function below the level; spinal shock (initial flaccidity/areflexia) then UMN signs
  • Brown-Séquard (hemisection): IPSILATERAL motor + dorsal-column loss, CONTRALATERAL pain/temperature loss
  • Anterior cord (anterior spinal artery): bilateral motor + pain/temperature loss, dorsal columns SPARED
  • Central cord (older, hyperextension): arms > legs weakness

Red flags

  • Acute trauma → immobilise/C-spine; neurogenic shock (hypotension + bradycardia); respiratory compromise if high cervical

Differentials & how to tell them apart

Subacute combined degeneration of the cordB12 deficiency — dorsal columns + corticospinal tracts, symmetrical, no trauma
Anterior spinal artery occlusionspares dorsal columns (proprioception/vibration intact)
Transverse myelitisinflammatory, complete level, MRI signal change
Syringomyelia"cape" dissociated sensory loss (pain/temp) in the upper limbs

Investigations

CT/MRI spine; ABCDE + C-spine immobilisation in trauma; identify the level and pattern.

Management

Immobilise + ABCDE; identify level/pattern; specialist spinal management

  1. 1Trauma: ABCDE with C-spine immobilisation, treat neurogenic shock; urgent imaging and spinal surgical referral.Gate: Neurogenic shock (hypotension WITH bradycardia from sympathetic loss) is distinct from hypovolaemic shock — do not just keep pouring fluids; it may need vasopressors/atropine
  2. 2Specialist spinal unit; prevent secondary injury; rehabilitation; bladder/skin/DVT care.
Supportive — no good evidence for steroids in traumatic cord injury; manage shock

Key points

Recognise the dissociation: Brown-Séquard (ipsilateral motor/proprioception, contralateral pain/temp); anterior cord spares the dorsal columns; central cord hits arms more than legs.

Monitor & prognosis

Neurological level, autonomic/respiratory function, complications.

Depends on completeness and level of injury.

Source: NICE NG41 (spinal injury)