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Spinal cord injury syndromes and ASIA grades
Incomplete spinal cord injury produces typical syndromes depending on the part injured — central, anterior, hemicord (Brown-Séquard) and posterior — each with its own pattern of deficit and prognosis; the ASIA scale defines whether the injury is complete, and the key question is whether sensation or movement is preserved in the sacral region.
Why it matters in the exam
Questions present a neurological examination after trauma and ask you to identify the syndrome or set the grade. Central cord syndrome is the most common: an older adult with a worn neck falls forward and strikes the chin (hyperextension), and weakness in the arms is worse than in the legs; the prognosis is relatively good, especially for walking. Anterior cord syndrome results from flexion or injury to the anterior spinal artery: paralysis and loss of pain and temperature sensation below the injury, with preserved position and vibration sense; the worst prognosis. Brown-Séquard syndrome usually results from penetrating injury: weakness and loss of position sense on the same side, and contralateral loss of pain and temperature sensation; the best prognosis. The ASIA scale grades from A (complete injury, no sensation or movement at S4–S5) to E (normal). Distinguish spinal shock — a temporary loss of reflexes below the injury, whose end is marked by return of the bulbocavernosus reflex — from neurogenic shock, in which there is low blood pressure with a slow pulse in an injury above T6, because of loss of sympathetic tone. Initial care under ATLS principles includes spinal immobilisation, airway, oxygenation and a high mean arterial pressure (about 85–90 mmHg) in the first days. CT is the first imaging test in an adult with suspected injury, and MRI is done when there is a neurological deficit. Early surgical decompression, within 24 hours, is considered when the cord is compressed; high-dose steroids are not routine treatment.
Key points
- Central cord — arms more than legs, in an older adult with hyperextension.
- Anterior cord — position and vibration preserved, the worst prognosis.
- Brown-Séquard — same-side weakness, opposite-side loss of pain and temperature.
- ASIA A — no sacral sparing; B–D — incomplete.
- Neurogenic shock: low blood pressure and slow pulse above T6.
Summary table
| Syndrome | Typical mechanism | Findings | Prognosis |
|---|---|---|---|
| Central cord | Hyperextension of a worn neck in an older adult | Weakness in the arms more than the legs | Relatively good, especially for walking |
| Anterior cord | Flexion, anterior spinal artery injury | Paralysis and loss of pain and temperature; position and vibration preserved | The worst |
| Brown-Séquard | Penetrating injury | Same-side weakness and loss of position sense; opposite-side loss of pain and temperature | The best |
| Posterior cord | Rare; hyperextension | Loss of position and vibration sense, unsteady gait | Variable |
| ASIA A versus B–D | — | A: no sensation or movement at S4–S5; B–D: sacral sparing | Incomplete injury — better chance of recovery |
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Sources
- ISNCSCI / ASIA International Standards, 2019 revision — Neurological Classification of Spinal Cord Injury
- NICE Guideline NG41, 2016 — Spinal injury: assessment and initial management
- AO Spine Clinical Practice Guideline, 2017 — Management of Acute Spinal Cord Injury
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.