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A 35-year-old Caucasian is brought to the emergency room after he jumped from fourth floor of a burning building. On examination he has Temperature: 36.9C(98.5F); PR: 90/min; RR: 20/min; BP: 90/40mm Hg, with a fracture of right tibia. He is conscious and his pupils are b laterally equal and reactive to light and accommodation. His neurological examination shows paraplegia, with loss of pain and temperature in both the legs but normal proprioception. Upper extremities do not show any neurological deficits. Passive straight leg raising test is negative. A CT scan of spine shows burst fracture at level of fourth thoracic vertebra. What is the most likely diagnosis in this patient?
A. Central cord syndrome.
B. Anterior cord syndrome.
C. Brown Sequard syndrome.
D. Acute disk prolapse.
E. Cauda equine syndrome.
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Anterior cord syndrome is a medical condition where the blood supply to the anterior portion of the spinal cord is interrupted. It is characterized by loss of motor function below the level of injury, loss of sensations carried by the anterior columns of the spinal cord (pain and temperature), and preservation of sensations carried by the posterior columns (fine touch and proprioception).
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He is conscious and his pupils are bilaterally equal and reactive to light and accommodation.
(No signs of intracranial hemmorhage. UMN lesion signs less likely, though can not be ruled out.)
His neurological examination shows paraplegia, with loss of pain and temperature in both the legs
(UMN or LMN lesion)
but normal proprioception.
(dorsal column intact)
Upper extremities do not show any neurological deficits.
(Site of lesion is below level of upper extremities)
Passive straight leg raising test is negative.
(Acute disc prolapse ruled out)
A CT scan of spine shows burst fracture at level of fourth thoracic vertebra.
(Spinal cord injury and/or ishemia)
What is the most likely diagnosis in this patient?
(Signs limited to motor system - anterior part of spinal cord. Sensations intact - dorsal column unaffected. Likely diagnosis is anterior compartment syndrome.)
