This document provides an overview of spinal cord anatomy and clinical syndromes related to spinal cord injury: - It describes the basic anatomy of the spinal cord and its relationship to the vertebrae. - It then covers different clinical syndromes that can result from spinal cord injury like anterior cord syndrome, posterior cord syndrome, and Brown-Sequard syndrome. - It discusses specific injuries and conditions like spinal cord compression, disc herniation, syringomyelia, and how they present clinically. - Practice questions at the end test understanding of topics like ventral horn involvement in ALS and clinical features of different spinal cord syndromes.

1. Board Review
Dr. Renu Yadav
Neuroscience

3. Division of brain

4. Organization of spinal cord

5. Introduction
• Spinal cord has inner grey matter and outer white
mater.
• There are 12 pairs of cranial nerves that leave the
brain and pass through foramina in the skull.
• There are 31 pairs of spinal nerves
• The spinal nerves are associated with regions of
the spinal cord: 8 cervical, 12 thoracic, 5 lumbar, 5
sacral, and 1 coccygeal.
• Note that there are 8 cervical nerves yet only 7
cervical vertebrae and that there Is 1 coccygeal
nerve but 4 coccygeal vertebrae.

6. Introduction..continue
• Unlike the spinal cord, the brain
Is composed of an inner core of
white matter. which Is
surrounded by an outer
covering of gray matter.
• Certain important masses of
gray matter are situated deeply
within the white matter:

7. Applied aspect of spinal cord
Spinal cord
compression:
Hematoma
Cancer
Epidural abscess
General presentation;
Sensory disturbance
Lower extremity weakness
Sphincter dysfunction
Pain
Hyper-reflexia

8. Posterior cord syndrome
Causes
• Inflammatory (e.g. multiple sclerosis)
• Syphilis
• Ischaemia (e.g. posterior spinal artery
syndrome)
• Malignancy
• Metabolic (e.g. subacute degeneration of the
cord due to vitamin B12 deficiency)
• Hereditary
The syndrome is characterized by gait
ataxia (abnormal, uncoordinated gait with
a wide base and irregular foot placement),
abnormal vibration sense, and
paraesthesia below the level of the injury.

9. Anterior cord syndrome
features
• Bilateral weakness (paraplegia
or quadriplegia): depends on
the level of the lesion
• Bilateral loss of pain and
temperature
• Autonomic dysfunction:
abnormal blood pressure
• Bladder dysfunction:
Aetiology
Thromboembolism
Trauma
Hypotension
Aortic disease

10. Brown-Sequard syndrome
• Brown-Sequard syndrome, also known
as hemisection of the cord, is a classic
cord syndrome that results in
ipsilateral (same side as the lesion)
weakness and
proprioception/vibration loss,
• and contralateral (opposite side to the
lesion) pain/temperature loss. It is
typically due to damage to one-half of
the cervical or thoracic spinal cord.
• Horner’s syndrome (Triad: miosis,
ptosis, anhidrosis): if the lesion is
above T1, hemisection of the cord
affects the first order sympathetic
neuron
Aetiology
Gun-shot wound
Stabbings
Road-traffic collision

11. Central cord syndrome
Features
• Weakness: upper extremity weakness > lower
extremity weakness. Neurons to the upper
extremities are more densely represented
within the medial part of the lateral
corticospinal tract
• Pain and temperature loss: usually located at
the level of the lesion in a ‘cape-like’
distribution affecting the upper back and
upper extremities. This is known as a
‘suspended sensory level’.
• Neck pain: commonly due to the mechanism
of injury (hyperextension injury in trauma).
• Normal vibration and proprioception (dorsal
columns unaffected)
• Urinary retention may occur
•Aetioogy
•Intramedullary tumor (i.e. tumours arising
within the spinal cord)
•Syringomyelia: fluid-filled cyst within the spinal
cord

12. Applied aspect of spinal cord
Syringomyelia
Most common in cervical spine.
Communicating type= Arnold Chiari
malformation
Non-communicating= Trauma, tumour
Presentation:
loss of pain and temperature,
sensation of light touch across neck
and arm
Sparing vibration, tactile sensation
Absent reflexes

13. •Why this happen?

14. I Dorsal root - Posteromarginal nucleus : mediate pain, touch ,pressure & temperature
II Below I - Substantia gelatinosa : pain , touch ,pressure ,temperature
III &
IV
Below II - Nucleus proprious or proper sensory nucleus receives input from substantia gelatinosa
V Neck of dorsal horn - receives descending fibers : corticospinal & rubrospinal , gives axons of
spinothalamic tract
VI Cervical & lumbar enlargement,, - receives descending fibers : corticospinal & rubrospinal , receives
afferent from spindles ,joint
VII Nucleus dorsalis of clarke column – C8- L2, muscle & tendon afferents, spinocerebellar tract,
interomediolateral column – sympathetic preganglionic T1 – L 3, Parasympathetic neurons – S2 – S3,
renshaw cells
VIII ,IX Ventral horn – alpha & gamma motor neurons
X Gray matter surrounding central canal

17. Fasciculi gracili & cuneatus

18. Applied aspect
• Respiration ceases if the cord is completely severed above the segmental
origin of the phrenic nerves (C3-C5) because the lntercostal muscles and
the diaphragm are paralyzed, resulting In death.
• In fracture dislocations of the thoracic region, displacement can be
conslderable. The small size of the vertebral canal results in severe injury
to this region of the spinal cord.

19. Disc herniation
• Herniation of the lntervertebral discs occurs most commonly In areas
of the vertebral column where a mobile part joins a relatively
Immobile part- e.g the cervicothoracic and lumbosacral Junctions.
• lumbar disc herniation is ore common: pain Is referred down the leg
and foot in the distribution of the affected nerve. Because the
sensory posterior roots most commonly pressed on are the 5th
lumbar and 1st sacral, pain ls usually felt down the back and lateral
side of the leg, radiating to the sole of the foot, a condition known as
8datica. In severe cases, paresthesla or actual sensory loss may occur.

20. Spinal tap (lumbar puncture)
• The spinal cord terminates inferiorly at the level of the lower border of
the 1st lumbar vertebra in adults (in Infants, It may reach Inferiorly to the
3rd lumbar vertebra).
• An Imaginary line joining the highest points on the iliac crests passes over
the 4th lumbar spine.
• The needle will pass through the following anatomical structures before It
enters the subarachnoid space: (a) skin, (b) superficial fascia, (c)
supraspinous ligament, (d) lnterspinous ligament, (e) ligamentum flavum,
(f) areolar tissue containing the internal vertebral venous plexus, (g) dura
mater, and (h) arachnoid mater.

21. Lumbar puncture
• If the needle stimulates one of
the nerve roots of the cauda
equlna, the patient will
experience a fleeting discomfort
In one of the dermatomes or a
muscle will twitch, depending on
whether a sensory or a motor
root was affected.

22. Practice Question
A 45-year-old man complained to his physician that the
muscles of his upper limb were weak and he felt clumsy
while walking. Tests revealed that he had amyotrophic
lateral sclerosis (Lou Gehrig's disease), a disease which
attacks the neurons of the voluntary motor system.
Where would one expect to see atrophic or
degenerated nerve cell bodies?
A. Dorsal horn of the spinal cord
B. Dorsal root ganglion
C. Lateral horn of the spinal cord
D. Ventral horn of the spinal cord
E. Lateral horn of the spinal cord

23. Practice Question
Sensory information on its way from your hand to the cerebral cortex
would pass through the following structures in what sequence?
1.medulla oblongata,2.midbrain,3.pons, 4.spinal cord,5.thalamus
A. 4-1-3-2-5
B. 4-1-2-3-5
C. 4-1-2-5-3
D. 4-2-1-3-5
E. 5-2-1-3-4

24. Practice Question
When comparing the dorsal and anterior spinocerebellar
tracts it can be said that:
A. Both ascend in the lateral funiculus
B. Both carry proprioception to conscious levels
C. Both are ipsilateral pathways
D. Both are primary sensory fibers arising from first-order
neurons located in dorsal root ganglia

25. Practice Question
A female 36 is admitted in emergency due to car accident , vital
signs are present , on clinical examination results in loss of pain
,touch & temperature sensation both sides below the damaged
vertebrae ,but two point discrimination ,vibratory &
Proprioception is preserved, clinical syndrome seen here is
a. spinal shock syndrome
b. Anterior cord syndrome
c. Pyramidal tract lesion
d. Central cord syndrome
e. Posterior cord syndrome

26. Practice Question
When comparing the dorsal and anterior spinocerebellar tracts it
can be said that:
A. Both ascend in the lateral funiculus
B. Both originate from all levels of the spinal cord
C. Both carry proprioception to conscious levels
D. Both are ipsilateral pathways
E. Both are primary sensory fibers arising from first-order neurons
located in dorsal root ganglia

27. THANK YOU