Central Cord Syndrome (CCS)
Type of incomplete spinal cord injury that affects the
central part of the spinal cord
What are the nerves that are affected or damage?
The most commonly affected nerves are:
C5-C6 nerve roots (C5-provides sensation from
the upper arm down to your elbow. Crenial nerve no.6-
Control the extensor muscles of your wrist and involves in
the control of your biceps, also C6 provides sensation of
the tumb side of your forearm and hand.)
C7 nerve root ( controls your triceps and wrist
extensor muscles.
C8 nerve root (controls your hands and gives
sensation to pinky sides of your hands and forearm.
Signs and symptoms (can vary depending on the severity
of the injury, but common manifestation are:
1. Weakness or paralysis on the arm and legs( Why may
legs? Puwede din po kasing ma apektohan ang mga
nerves na cumocontrol sa paa mas appektado lang po
ang kamay kasi yung mga nurves ay nasa gintna)
2. Decrease sensation
3. Loss of fine motor skills ( ex: holding small objects,
buttoning your shirt )
4. Spasticity (Stiffness of the hand)
5. Babinski reflex (an abnormal reflex where the big toe
flexes upwards when stimulated)
6. Difficulty with coordination and balance
NX Managemet
1. *: Position the patient to prevent contractures and promote
optimal mobility.
2. *Range-of-motion exercises*: Regularly perform exercises to
maintain range of motion in the shoulders, elbows, wrists, and
hands.
3. *Splinting*: Use splints to maintain alignment and prevent
contractures in the arms and hands.
4. *Pain management*: Manage pain using pharmacological
and non-pharmacological interventions, such as physical
therapy and relaxation techniques.
5. *Neurological assessment*: Regularly assess the patient's
neurological status to monitor for any changes or deterioration.
6. *Safety measures*: Ensure the patient's safety by providing
support with daily activities, such as bathing, dressing, and
feeding.
Brown-Sequard syndrome (BSS)
is a neurological condition characterized by the
hemisection of the spinal cord, resulting in damage to one
side of the spinal cord. (This damage often occurs due to a
traumatic injury, such as a spinal cord injury, or a condition
like syringomyelia, which leads to a cavity formation within
the spinal cord. The resulting injury disrupts
communication between the brain and the affected side of
the body below the level of injury, causing a range of
symptoms.
What are the nerves that are affected or damage?
In Brown-Sequard syndrome, the nerves affected are usually
those on the affected side of the spinal cord, which includes:
Lateral corticospinal tract*: Responsible for motor control
and movement on the affected side.
Lateral spinothalamic tract*: Carries pain and temperature
sensation from the affected side.
Dorsal columns (Fasciculus gracilis and fasciculus
cuneatus)*: Responsible for proprioception (position
sense) and vibration from the affected side
Signs and symptoms
*On the affected side:*
1. Paralysis or weakness (due to damage to the lateral
corticospinal tract)
2. Loss of pain and temperature sensation (due to damage
to the lateral spinothalamic tract)
3. Loss of proprioception (due to damage to the dorsal
columns)
*On the opposite side:*
1. Hyperreflexia (increased reflexes) due to damage to the
pyramidal tract
2. Abnormal sensations, such as numbness, tingling, or
burning, due to injury to the spinothalamic tract
3. Increased sensitivity to pain on the opposite side of the
body
Anterior cord syndrome
This syndrome occurs due to damage to the anterior two-
thirds of the spinal cord, usually from flexion injuries,
ischemia, or trauma.
The affected areas of the spinal cord primarily include:
The anterior horn cells (located in the anterior portion of the
spinal cord) which are responsible for motor function.
The spinothalamic tracts, which transmit pain and
temperature sensations.
The corticospinal tracts, which control voluntary motor
muscle movements.
Signs and Symptoms
Signs and symptoms of anterior cord syndrome can vary based
on the severity of the injury but typically include:
1. Loss of Motor Function: Weakness or paralysis in the arms
and legs, depending on the level of the injury, with more
pronounced effects in the legs.
2. Loss of Pain and Temperature Sensation: Inability to feel
pain and temperature below the level of injury.
3. Preservation of Proprioception and Vibration Sense: These
senses remain intact due to the preservation of the dorsal
columns.
4. Bowel and Bladder Dysfunction: Possible loss of control or
function, depending on the injury's severity and specific
areas affected.
Posterior Cord Syndrome (PCS)
Rare type of incomplete spinal cord injury that
predominantly affects the posterior columns of the spinal
cord.
Depending on the level of injury (cervical, thoracic, or
lumbar), the specific nerve fibers may vary, but it mainly
disrupts the function of the following:
Dorsal columns (fasciculus cuneatus and fasciculus
gracilis): responsible for transmitting
proprioception (sense of the bodies position) and
fine touch from the body to the brain.
pinocerebellar tracts may also be involved, leading
to coordination problems.
Signs and Symptoms
Common signs and symptoms of Posterior Cord Syndrome
include:
1. Loss of proprioception: Patient may have difficulty
knowing the position of their limbs.
2. Loss of vibratory sense: Inability to feel vibration on the
skin.
3. Loss of fine touch sensation: Patient may find it difficult to
identify objects by touch alone.
4. Intact pain and temperature sensation: These sensations
are mediated by spinothalamic tracts, which are typically
preserved.
Motor function may remain intact, which is one distinguishing
characteristic of this syndrome.
Conus medullaris syndrome,
Also known as cauda equina syndrome when referring to
the lower lumbar and sacral nerves, is a neurological
disorder that occurs when there is damage to the lower
spinal cord, specifically within the conus medullaris.
The conus medullaris is the lower part of the spinal cord,
consisting of the most caudal (tail-like) portion, which
terminates at the level of the first or second sacral
vertebrae. This damage results in a combination of
neurological, urinary, and bowel symptoms.
Conus medullaris syndrome primarily affects the S2-S5
nerve roots, as well as the nerve roots of the lower sacrum
Signs and Symptoms:
Pathognomonic sign is the presence of saddle anesthesia. This
is characterized by a loss of sensation on the perineum and
genital areas, resembling a saddle over the patient's buttocks
when they are sitting down. (s1 and s2 is affected)
1. Motor symptoms:*
Loss of reflexes
Loss of muscle strength
Paralysis of the anal and urethral sphincters
Decreased ability to walk or bear weight
2. Sensory symptoms:*
Decreased sensation around the anus and perineum
Decreased sensation in the genital areas
Decreased sensation in the legs
3. Autonomic symptoms:
Bladder and bowel dysfunction (urinary retention,
constipation, or fecal incontinence)
Decreased sweating or flushing around the anus and
genital areas
Changes in blood pressure
