Anterior cord syndrome

Background

Spinal cord tracts

Clinical Features

  • Paraplegia below level of lesion (corticospinal)
  • Loss of pain/temperature (lateral spinothalamic)
  • Autonomic dysfunction, orthostasis
  • Bowel, bladder, sexual dysfunction
  • Preservation of modalities carried by dorsal columns i.e. vibration, proprioception, 2-point discrimination

Differential Diagnosis

Spinal Cord Syndromes

Evaluation

  • Labs based on severity
    • ABG if lesion affects above C5
    • Shock labs if neurogenic shock
    • Trend CBC to rule out hemorrhagic shock
  • Imaging with CT and MRI

Management

  • Consider intubation injuries at C5 or above
  • Consider surgical intervention for:
  • Steroids are no longer recommended
    • Administration of methylprednisolone (MP) for the treatment of acute spinal cord injury (SCI) is not recommended. Clinicians considering MP therapy should bear in mind that the drug is not Food and Drug Administration (FDA) approved for this application. There is no Class I or Class II medical evidence supporting the clinical benefit of MP in the treatment of acute SCI. Scattered reports of Class III evidence claim inconsistent effects likely related to random chance or selection bias. However, Class I, II, and III evidence exists that high-dose steroids are associated with harmful side effects including death.[1]
    • See EBQ:High Dose Steroids in Cord Injury for further discussion
  • Neurogenic shock management

Prognosis

  • Poor

Disposition

  • Admit

External Links

See Also

References

  1. Hurlbert RJ et al. Pharmacological therapy for acute spinal cord injury. Neurosurgery. 2013 Mar;72 Suppl 2:93-105 http://www.ncbi.nlm.nih.gov/pubmed/23417182
Last modified on 5 September 2016, at 16:20