Spinal Cord Stroke Syndromes


The anterior spinal artery syndrome is characterized by an abrupt onset of flaccid paraplegia or tetraplegia below the level of the lesion due to bilateral corticospinal tract damage. There is thermoanesthesia and analgesia below the level of the lesion due to compromise of the spinothalamic tracts bilaterally. Position, vibration, and light touch are spared due to preservation of the dorsal columns, which

are supplied by the posterior spinal arteries. Bowel and bladder function is impaired. There may be associated radicular or "girdle" pain.

These infarctions most commonly occur in the "watershed" areas or boundary zones where the distal branches of the major arterial systems of the cord anastomose, between the T1 and T4 segments and at the L1 segment. Common etiologies of arterial spinal cord infarction are detailed in Tabje.22-3..


The posterior spinal artery syndrome is uncommon, probably due to the presence of numerous posterior radicular arteries and the reversal of flow that is possible at the conus medullaris if there is compromise of the artery of Adamkiewicz. The characteristics of this syndrome are loss of proprioception and vibration sense below the level of the lesion and loss of segmental reflexes. The common etiologies are listed in Table..22:3 .

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