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can anyone explain ant., central cord syndromes as well brown sequard syn . in relation to tracts of sp. cord

anterior .............name indicates lesion in ant part of the cord.

central............is central cavity.

brown sequard.................hemisection.

for further explanations conact kaplan lectures notes, INTERNAL MEDICINE.

Anterior cord syndrome is commonly associated with burst fracture of the vertebra and is characterized by total loss of motor function below the level of lesion with loss of pain and temperature on both sides below the lesion with intact proprioception. MRI is the best investigation to study the extent of neurological damage.

Central cord syndrome is characterized by burning pain and paralysis in upper extremities with relative sparing of lower extremities. It is commonly seen in elderly secondary to forced hyperextension type of injury to the neck.

Brown Sequard syndrome is acute hemisection of cord and is characterized by ipsilateral motor and proprioception loss and contra lateral pain loss below the level of lesion.


Cauda equine syndrome is characterized by paraplegia, variable sensory loss, urinary and fecal incontinence.

i wanted to know the neuroanatomy aspects with the tracts of these lesions because i am not done with the step-1

well even i am not done..lol..lets wait for more replies

i can tell u what to do now. donot open kaplan but try HY neuroanatomy . hope it helps.

docnar thanks alot.

it will take two hours to read Hy neuro anatomy

dont read the whole book .

Lets organize this thing:

First:
In Spinal cord you will probably be tested in this 6 classic lesions:
a. Tabaes dorsalis: seen in tertiary syphilis. Pt with bilateral loss of touch, vibration and tactile sense from lower limbs do tue lesion of fasciculus gracilis

b. Amiotrophic lateral sclerosis: is a combined Upper and lower motor neuron lession fot he corticospinal tract.
Let's break what i said.
corticospinal tract means form up to down...that is descendent way
upper motor neuron lession means......you will have spastic pareasia an babinsky
lower motor neuron means...the same patient will have flacid paresia ( some times not seen because there is an overlaping symptoms with upper neuron) but you will se fascilculations that are very characteristic of lower motor neuron.

c. Brown Sequard..is the typical pt going night to the bar and stabbed in back....come to emergency and has a complete hemisection of medula.
This patiente can have ipsilateral loss of touch and vibration adn ipsilateral spastic paresia becouse the upper motor neurone fibers were cut. Also ipsilateral will be some sort of lower motor neuron damage sometimes no seen.
Contralateral will be just loss of pain and touch.
If the hemisection is very high, I mean pt stabbed in neck above T1 you will see Horner on the side of lesions. Horner are always ipsilateral.



Are u there rifampin....i can continue

you don't have to read all HY just read chapter 7 and 8 (five six pages). But here it goes:

First the important tracts:

ASCENDING
Dorsal Columns (dorsal or caudal as it name implies) carry proprioception for arms and legs (cuneAte for Arms graciLis for Legs) Vibration, position and tactile discrimination. Decussates frontally up in the medulla so everything is ipsilateral.

LSTT: carries pain and temperature. Enters and decussates so it's contralateral one segment under the lesion

DESCENDING
LCST is latero-caudal and causes UMN ipsilateral lesions. It decussates a bit higher than where they enter, so that is why it's ipsilateral at the site of the lesion. Characteristics include pyramidal signs and Babinski

REMEMBER: Ventral horns are motor Dorsal horns are temp/pressure.

NOW THE LESIONS:
Spinal cord anterior part will have either the ventral horn (which usually is affected in Polio bilaterally) or more commonly you will have the LSTT (lat spinothalamic tract) on the latero-anterior part of the cord.

ALS is a salad mix as elba mentions. UMN LMN disease. So you will have anterior horns and LCST which will give you ipsilateral SPASTIC paresis.

If the lesion is compromising more laterally you could get LCST and LSTT affected. So ipsilateral spastic paresis with loss of sensation contralaterally.

If you move more caudally and laterally you could affect again LCST dorsal horn and cuneatus. This will give you ipsilateral spastic paresis, local dermatomal symptoms (dorsal horn) and ipsilateral loss of proprioception in the arm.

If you are more caudally/medial then you get full limbs proprioception loss or partial if it's fully medial (ipsilateral also) only the legs. If bilateral like in tabes dorsalis or B12 deficiency then you lose all proprioception bilaterally.

Examples:
Anterior horns Polio
Posterior columns and some anterolateral lesions typically MS (so loss of proprioception ipsilateral with loss or temp and pain contralateral)
Posterior columns alone and more medial Tabes dorsalis
Anterior horns and LCST ALS
Hemisection is Brown Sequard so ipsilateral spasticity paresis (from CST) and flaccid paralysis of muscles affected (fromt he ant horns), ipsilateral proprioception with contralateral pain and temp along with bilateral loss of pain in dermatomes.
Everything affected except proprioception and posterior horns means spinal artery oclussion
Proprioception full (arms and legs) with spastic paresis is B12 although usually it's presented only as proprioception and is always bilateral if it's unilateral think tumor
And our dear friend syringomyelia gives affection to ventral horns so flaccid paralysis and proprioception bilateral b/c it affects the ventral white commisure which is where some of the uncrossed VCST fibers travel

Long but I hope it helps!
bdj