Anterior cord syndrome - Revision history

Danbot: Expand with concise EM-focused content: etiology, clinical features, evaluation, management, prognosis

2026-03-21T01:15:06Z

Expand with concise EM-focused content: etiology, clinical features, evaluation, management, prognosis

← Older revision		Revision as of 01:15, 21 March 2026
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	[[File:Spinal cord tracts.svg\|thumb\|Spinal cord tracts]]		[[File:Spinal cord tracts.svg\|thumb\|Spinal cord tracts]]
	[[File:Anterior Cord.png\|thumb\|Anatomy of anterior cord injury.]]		[[File:Anterior Cord.png\|thumb\|Anatomy of anterior cord injury.]]
	*~~Etiology~~		*Injury to the anterior two-thirds of the spinal cord, sparing the posterior columns
	**~~Direct anterior [[Cord Compression]]~~ (~~e.g. disc protrusion, posterior [[abdominal aortic aneurysm]], mass~~)		*Etiologies:
			**Anterior spinal artery occlusion/thrombosis (most common non-traumatic cause)
	**Hyperflexion injury of cervical spine		**Hyperflexion injury of cervical spine
	**~~Thrombosis of~~ anterior ~~spinal artery~~		**Direct anterior cord compression (disc herniation, fracture-dislocation, mass)
			**Aortic pathology: [[abdominal aortic aneurysm\|AAA]] repair, [[nontraumatic thoracic aortic dissection\|aortic dissection]] (watershed ischemia)

	==Clinical Features==		==Clinical Features==
	*[[weakness\|Paraplegia]] below level of lesion (corticospinal)		*'''Motor:''' [[weakness\|Paraplegia]] or quadriplegia below the level of the lesion (corticospinal tracts)
	*~~[[numbness\|~~Loss of pain~~]]/~~temperature (~~lateral~~ spinothalamic)		*'''Sensory:''' Loss of pain and temperature below the lesion (spinothalamic tracts)
	*Autonomic dysfunction, [[hypotension\|~~orthostasis~~]]		*'''Preserved:''' Proprioception, vibration, and light touch (dorsal columns intact — distinguishing feature)
	*Bowel, bladder, sexual dysfunction		*Autonomic dysfunction: [[hypotension\|orthostatic hypotension]], bowel/bladder/sexual dysfunction
	*~~Preservation~~ of ~~modalities carried by dorsal columns i.e. vibration, proprioception, 2-point discrimination~~		*Most devastating of the incomplete cord syndromes

	==Differential Diagnosis==		==Differential Diagnosis==
	{{Spinal cord syndromes DDX}}		{{Spinal cord syndromes DDX}}
	*Etiologies
	**[[Trauma]], [[vertebral fractures]]
	**Ischemia, atherosclerosis, anterior spinal artery
	**Malignancy
	**[[Infection]]
	**Spondylosis, disk herniation
	**Aortic disease - [[AAA\|aneurysm]], [[dissection]]
	**Iatrogenic - spinal injections, epidural catheters, aortic cross-clamp

	==Evaluation==		==Evaluation==
	*~~Labs based on severity~~		*MRI spine — gold standard; shows anterior cord infarction or compression
	**[[ABG]] if lesion affects above C5		*CT angiography if aortic pathology suspected
	**Shock labs if ~~[[neurogenic shock]]~~		*MRA or conventional angiography for anterior spinal artery occlusion
	**Trend CBC to rule out [[hemorrhagic shock]]		*Neurological exam: document motor level, sensory level (pinprick vs light touch), rectal tone
	*~~Imaging with CT and MRI~~

	==Management==		==Management==
	{{Acute spinal cord injury treatment}}		{{Acute spinal cord injury treatment}}
			*Treat underlying cause:
			**Surgical decompression for compressive etiologies (disc, fracture, mass)
			**Aortic repair if caused by dissection/aneurysm
			**Anticoagulation consideration for thrombotic etiologies (in consultation with neurology/neurosurgery)

			==Prognosis==
			*Worst prognosis of incomplete spinal cord syndromes
			*Only 10-20% regain functional motor recovery
			*Sensory recovery (pain/temperature) may be slightly better than motor

	==Disposition==		==Disposition==
	*Admit		*Admit all patients — neurosurgery or spine surgery consult
			*ICU for high cervical lesions or hemodynamic instability
	~~===Prognosis===~~		*Vascular surgery consult if aortic etiology
	*~~Poor~~

	~~==External Links==~~

	==See Also==		==See Also==
	*[[Spinal cord syndromes]]		*[[Spinal cord syndromes]]
			*[[Brown-Séquard syndrome]]
			*[[Central cord syndrome]]
			*[[Posterior cord syndrome]]

	==References==		==References==

Rossdonaldson1: /* Background */

2020-10-24T11:24:15Z

Background

← Older revision		Revision as of 11:24, 24 October 2020
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	[[File:Dermatoms alt.png\|thumb\|Sensory dermatome by spinal level.]]		[[File:Dermatoms alt.png\|thumb\|Sensory dermatome by spinal level.]]
	[[File:Spinal cord tracts.svg\|thumb\|Spinal cord tracts]]		[[File:Spinal cord tracts.svg\|thumb\|Spinal cord tracts]]
			[[File:Anterior Cord.png\|thumb\|Anatomy of anterior cord injury.]]
	*Etiology		*Etiology
	**Direct anterior [[Cord Compression]] (e.g. disc protrusion, posterior [[abdominal aortic aneurysm]], mass)		**Direct anterior [[Cord Compression]] (e.g. disc protrusion, posterior [[abdominal aortic aneurysm]], mass)

Rossdonaldson1: /* Background */

2020-10-24T11:10:53Z

Background

← Older revision		Revision as of 11:10, 24 October 2020
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	==Background==		==Background==
	[[File:Dermatoms alt.png\|thumb\|Sensory dermatome by spinal level.]]		[[File:Dermatoms alt.png\|thumb\|Sensory dermatome by spinal level.]]
			[[File:Spinal cord tracts.svg\|thumb\|Spinal cord tracts]]
	*Etiology		*Etiology
	**Direct anterior [[Cord Compression]] (e.g. disc protrusion, posterior [[abdominal aortic aneurysm]], mass)		**Direct anterior [[Cord Compression]] (e.g. disc protrusion, posterior [[abdominal aortic aneurysm]], mass)
	**Hyperflexion injury of cervical spine		**Hyperflexion injury of cervical spine
	**Thrombosis of anterior spinal artery		**Thrombosis of anterior spinal artery

	~~[[File:Spinal cord tracts.svg\|thumb\|Spinal cord tracts]]~~

	==Clinical Features==		==Clinical Features==

Rossdonaldson1: /* Background */

2020-10-24T11:10:37Z

Background

← Older revision		Revision as of 11:10, 24 October 2020
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	==Background==		==Background==
			[[File:Dermatoms alt.png\|thumb\|Sensory dermatome by spinal level.]]
	*Etiology		*Etiology
	**Direct anterior [[Cord Compression]] (e.g. disc protrusion, posterior [[abdominal aortic aneurysm]], mass)		**Direct anterior [[Cord Compression]] (e.g. disc protrusion, posterior [[abdominal aortic aneurysm]], mass)

Rossdonaldson1: /* Management */

2020-10-24T10:36:18Z

Management

← Older revision		Revision as of 10:36, 24 October 2020
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	==Management==		==Management==
	{{Acute spinal cord injury treatment}}		{{Acute spinal cord injury treatment}}
	*[[Neurogenic shock]] management

	==Disposition==		==Disposition==

Rossdonaldson1 at 10:36, 24 October 2020

2020-10-24T10:36:06Z

← Older revision		Revision as of 10:36, 24 October 2020
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	{{Acute spinal cord injury treatment}}		{{Acute spinal cord injury treatment}}
	*[[Neurogenic shock]] management		*[[Neurogenic shock]] management

			==Disposition==
			*Admit

	===Prognosis===		===Prognosis===
	*Poor		*Poor

	~~==Disposition==~~
	*Admit

	==External Links==		==External Links==

ClaireLewis at 22:14, 1 October 2019

2019-10-01T22:14:24Z

← Older revision		Revision as of 22:14, 1 October 2019
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	==Clinical Features==		==Clinical Features==
	*Paraplegia below level of lesion (corticospinal)		*[[weakness\|Paraplegia]] below level of lesion (corticospinal)
	*Loss of pain/temperature (lateral spinothalamic)		*[[numbness\|Loss of pain]]/temperature (lateral spinothalamic)
	*Autonomic dysfunction, orthostasis		*Autonomic dysfunction, [[hypotension\|orthostasis]]
	*Bowel, bladder, sexual dysfunction		*Bowel, bladder, sexual dysfunction
	*Preservation of modalities carried by dorsal columns i.e. vibration, proprioception, 2-point discrimination		*Preservation of modalities carried by dorsal columns i.e. vibration, proprioception, 2-point discrimination
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	{{Spinal cord syndromes DDX}}		{{Spinal cord syndromes DDX}}
	*Etiologies		*Etiologies
	**Trauma, vertebral fractures		**[[Trauma]], [[vertebral fractures]]
	**Ischemia, atherosclerosis, anterior spinal artery		**Ischemia, atherosclerosis, anterior spinal artery
	**Malignancy		**Malignancy
	**Infection		**[[Infection]]
	**Spondylosis, disk herniation		**Spondylosis, disk herniation
	**Aortic disease - aneurysm, dissection		**Aortic disease - [[AAA\|aneurysm]], [[dissection]]
	**Iatrogenic - spinal injections, epidural catheters, aortic cross-clamp		**Iatrogenic - spinal injections, epidural catheters, aortic cross-clamp

	==Evaluation==		==Evaluation==
	*Labs based on severity		*Labs based on severity
	**ABG if lesion affects above C5		**[[ABG]] if lesion affects above C5
	**Shock labs if neurogenic shock		**Shock labs if [[neurogenic shock]]
	**Trend CBC to rule out hemorrhagic shock		**Trend CBC to rule out [[hemorrhagic shock]]
	*Imaging with CT and MRI		*Imaging with CT and MRI

ClaireLewis at 16:20, 5 September 2016

2016-09-05T16:20:52Z

← Older revision		Revision as of 16:20, 5 September 2016
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	==Background==		==Background==
	*Etiology		*Etiology
	**Direct anterior ~~cord compression~~		**Direct anterior [[Cord Compression]] (e.g. disc protrusion, posterior [[abdominal aortic aneurysm]], mass)
	**Hyperflexion injury of cervical spine		**Hyperflexion injury of cervical spine
	**Thrombosis of anterior spinal artery		**Thrombosis of anterior spinal artery
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	*Autonomic dysfunction, orthostasis		*Autonomic dysfunction, orthostasis
	*Bowel, bladder, sexual dysfunction		*Bowel, bladder, sexual dysfunction
	*Preservation of modalities carried by dorsal columns ie vibration, proprioception, 2-point discrimination		*Preservation of modalities carried by dorsal columns i.e. vibration, proprioception, 2-point discrimination

	==Differential Diagnosis==		==Differential Diagnosis==

Rossdonaldson1: Text replacement - "r/o" to "rule out"

2016-07-31T14:56:30Z

Text replacement - "r/o" to "rule out"

← Older revision		Revision as of 14:56, 31 July 2016
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	**ABG if lesion affects above C5		**ABG if lesion affects above C5
	**Shock labs if neurogenic shock		**Shock labs if neurogenic shock
	**Trend CBC to ~~r/o~~ hemorrhagic shock		**Trend CBC to rule out hemorrhagic shock
	*Imaging with CT and MRI		*Imaging with CT and MRI

Neil.m.young: Text replacement - "==Diagnosis==" to "==Evaluation=="

2016-07-24T00:21:49Z

Text replacement - "==Diagnosis==" to "==Evaluation=="

← Older revision		Revision as of 00:21, 24 July 2016
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	**Iatrogenic - spinal injections, epidural catheters, aortic cross-clamp		**Iatrogenic - spinal injections, epidural catheters, aortic cross-clamp

	==~~Diagnosis~~==		==Evaluation==
	*Labs based on severity		*Labs based on severity
	**ABG if lesion affects above C5		**ABG if lesion affects above C5