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Spinal cord syndromes
Every spinal cord syndrome is recognised by which tracts are hit: the motor tract and the position and vibration tract run on the same side, while the pain and temperature tract crosses at once — so every combination of deficits points to a specific part of the cord.
Why it matters in the exam
Questions present an injury or disease and ask which syndrome: weakness on one side with loss of pain on the other after a stab wound (Brown-Séquard), an older person who fell on the face with arms weaker than legs (central cord), sudden paralysis with preserved position sense after aortic surgery (anterior cord), or sensory ataxia with a positive Romberg in B12 deficiency (posterior cord). An important part is the difference between conus medullaris syndrome and cauda equina syndrome, which is a surgical emergency. Common distractors are mixing up the sides in Brown-Séquard, or thinking that "cape-like" loss of pain and temperature fits a peripheral nerve lesion.
Key points
- The pain tract crosses at once, while the motor and position tracts stay on the same side up to the brainstem.
- Brown-Séquard: weakness and position loss on the same side, pain and temperature loss on the opposite side.
- Central cord: arms weaker than legs; anterior cord: position and vibration preserved.
- Posterior cord: sensory ataxia and positive Romberg, mainly in B12 deficiency.
- Cauda equina is an emergency: urgent MRI and surgery.
Summary table
| Syndrome | Typical cause | Findings |
|---|---|---|
| Brown-Séquard (hemisection) | Penetrating injury | Weakness and loss of position and vibration on the same side; loss of pain and temperature on the opposite side, 1 to 2 segments below the lesion |
| Central cord | Neck hyperextension in an older person with stenosis; syringomyelia | Arms weaker than legs; "cape-like" loss of pain and temperature with touch and vibration preserved |
| Anterior cord | Anterior spinal artery infarct (aortic surgery or dissection) | Paralysis with loss of pain and temperature sensation under the level; position and vibration preserved |
| Posterior cord | B12 deficiency, copper deficiency, nitrous oxide, tertiary syphilis | Loss of position and vibration, sensory ataxia, positive Romberg |
| Conus versus cauda equina | Conus — lesion at the end of the cord; cauda equina — large disc, tumour, haematoma | Conus: early, symmetric sphincter failure; cauda equina: radicular pain, asymmetric deficit, absent reflexes — urgent MRI and surgery |
| Transverse myelitis | Multiple sclerosis, NMOSD, infection, post-infectious inflammation | Sensory level, weakness and sphincter failure over hours to days; MRI with gadolinium, steroids |
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Sources
- International Standards for Neurological Classification of Spinal Cord Injury (ASIA/ISNCSCI), 2019 — Clinical syndromes
- Transverse Myelitis Consortium Working Group: Proposed Diagnostic Criteria, 2002 — Acute transverse myelitis
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.