Anterior Cord Syndrome: Difference between revisions
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== Introduction == | == Introduction == | ||
[[File:Incomplete Spinal Cord Injury.png|thumb]] | [[File:Incomplete Spinal Cord Injury.png|thumb]] | ||
Anterior cord syndrome referred to as Anterior spinal artery syndrome (ASAS) or ventral cord syndrome (VCS)<ref>Santana JA, Dalal K. Ventral Cord Syndrome. 2021 Aug 26. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan–.</ref>. ASAS is an incomplete [[Spinal Cord Injury|spinal cord injury]](SCI) that is often related to flexion injuries of the cervical region that result in infarction of the | Anterior cord syndrome referred to as Anterior spinal artery syndrome (ASAS) or ventral cord syndrome (VCS)<ref>Santana JA, Dalal K. Ventral Cord Syndrome. 2021 Aug 26. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan–.</ref>. ASAS is an incomplete [[Spinal Cord Injury|spinal cord injury]](SCI) that is often related to flexion injuries of the cervical region that result in infarction of the anterior two thirds of the cord and/or its vascular supply from the anterior spinal artery.<ref>Deutsch JE, O’Sullivan SB. Stroke. In: O'Sullivan SB, Schmitz TJ, Fulk G, editors. | ||
Physical Rehabilitation.7th edition. Philadelphia: FA Davis; 2019. p.860</ref> Patients present with impairments in the pain and temperature sensations while the | Physical Rehabilitation.7th edition. Philadelphia: FA Davis; 2019. p.860</ref> Patients present with impairments in the pain and temperature sensations while the vibratory and proprioceptive sensations are preserved. Motor deficits are observable both at and below the level of injury.<ref>Santana JA, Dalal K. Ventral Cord Syndrome. [Updated 2021 Aug 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-.</ref> | ||
== Clinically Relevant Anatomy == | == Clinically Relevant Anatomy == | ||
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== Aetiology == | == Aetiology == | ||
== Pathological process == | |||
The ventral two-thirds of the cord contains important tracts for the<ref>Sandoval JI, De Jesus O. Anterior Spinal Artery Syndrome. 2021 Aug 30. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan–. </ref> proper functioning of the central nervous system (CNS); injury impairs the actions of these tracts. Motor function impairment arises from Damage to the efferent corticospinal tract results in motor functio impairment and sensory deficits occur from damage<ref>Wagner R, Jagoda A. Spinal cord syndromes. Emerg Med Clin North Am. 1997 Aug;15(3):699-711. doi: 10.1016/s0733-8627(05)70326-6.</ref> to the afferent spinothalamic and spinocerebellar tracts. | |||
== Clinical Presentation == | |||
Other manifestations of the syndrome will depend on the location where the cord was injured. In general, there is a risk for autonomic dysreflexia, sexual impairments, movement impediments, neuropathic pain, and neurogenic bladder and bowel.[6] | |||
The clinical onset of ventral cord syndrome is abrupt, with pain, flaccid paraplegia or tetraplegia below the lesion, and alterations in temperature and pain sensation.[7] Vibration, fine touch, and proprioception sensory modalities will not be affected, as these are relayed by the dorsal columns which are located in the posterior one-third of the cord and are supplied by the two posterior spinal arteries. | |||
=== Motor === | |||
=== Sensory === | |||
== Diagnostic Procedures == | == Diagnostic Procedures == | ||
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* Spinal cord neoplasm | * Spinal cord neoplasm | ||
* Meningitis/encephalitis | * Meningitis/encephalitis | ||
== References == | |||
Revision as of 14:40, 31 December 2021
Introduction[edit | edit source]
Anterior cord syndrome referred to as Anterior spinal artery syndrome (ASAS) or ventral cord syndrome (VCS)[1]. ASAS is an incomplete spinal cord injury(SCI) that is often related to flexion injuries of the cervical region that result in infarction of the anterior two thirds of the cord and/or its vascular supply from the anterior spinal artery.[2] Patients present with impairments in the pain and temperature sensations while the vibratory and proprioceptive sensations are preserved. Motor deficits are observable both at and below the level of injury.[3]
Clinically Relevant Anatomy[edit | edit source]
ASAS is caused by ischemia within the anterior spinal artery (ASA), which supplies blood to the anterior 2/3rd of the spinal cord. The anterior spinal artery, with a few radicular artery contributions, supplies blood to the bilateral anterior and lateral horns of the spinal cord, as well as the bilateral spinothalamic tracts and corticospinal tracts. The anterior horns and corticospinal tracts control the somatic motor system from the neck to the feet. The lateral horns span T1-L2 of the spinal cord and sheathe the neuronal cell bodies of the sympathetic nervous system. The spinothalamic tracts carry pain and temperature sensory information.
Aetiology[edit | edit source]
Pathological process[edit | edit source]
The ventral two-thirds of the cord contains important tracts for the[4] proper functioning of the central nervous system (CNS); injury impairs the actions of these tracts. Motor function impairment arises from Damage to the efferent corticospinal tract results in motor functio impairment and sensory deficits occur from damage[5] to the afferent spinothalamic and spinocerebellar tracts.
Clinical Presentation[edit | edit source]
Other manifestations of the syndrome will depend on the location where the cord was injured. In general, there is a risk for autonomic dysreflexia, sexual impairments, movement impediments, neuropathic pain, and neurogenic bladder and bowel.[6]
The clinical onset of ventral cord syndrome is abrupt, with pain, flaccid paraplegia or tetraplegia below the lesion, and alterations in temperature and pain sensation.[7] Vibration, fine touch, and proprioception sensory modalities will not be affected, as these are relayed by the dorsal columns which are located in the posterior one-third of the cord and are supplied by the two posterior spinal arteries.
Motor[edit | edit source]
Sensory[edit | edit source]
Diagnostic Procedures[edit | edit source]
Outcome Measures[edit | edit source]
Management/Interventions[edit | edit source]
Non-surgical[edit | edit source]
Surgical[edit | edit source]
Prognosis[edit | edit source]
Differential Diagnosis[edit | edit source]
- Central cord syndrome
- Dorsal cord syndrome
- Brown-Séquard syndrome
- Conus medullaris syndrome
- Cauda equina syndrome
- Transverse myelitis
- Guillain-Barré syndrome
- Multiple sclerosis
- Spinal epidural abscess
- Epidural hematoma
- Disk herniation
- Spinal cord neoplasm
- Meningitis/encephalitis
References[edit | edit source]
- ↑ Santana JA, Dalal K. Ventral Cord Syndrome. 2021 Aug 26. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan–.
- ↑ Deutsch JE, O’Sullivan SB. Stroke. In: O'Sullivan SB, Schmitz TJ, Fulk G, editors. Physical Rehabilitation.7th edition. Philadelphia: FA Davis; 2019. p.860
- ↑ Santana JA, Dalal K. Ventral Cord Syndrome. [Updated 2021 Aug 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-.
- ↑ Sandoval JI, De Jesus O. Anterior Spinal Artery Syndrome. 2021 Aug 30. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan–.
- ↑ Wagner R, Jagoda A. Spinal cord syndromes. Emerg Med Clin North Am. 1997 Aug;15(3):699-711. doi: 10.1016/s0733-8627(05)70326-6.
