Source / episode info

• **Episode:**374
• **Title:**Divine Intervention Episode 374 – Spinal Cord Lesions (for Step 1-3)
• **Published:**2022-02-25
• Source:Episode page

One-liner

This episode provides a comprehensive review of spinal cord syndromes, detailing the distinct patterns of sensory (dorsal column vs. spinothalamic tract) and motor deficits seen in conditions like Brown-Séquard syndrome, Central Cord Syndrome, Anterior Spinal Artery Syndrome, Subacute Combined Degeneration, and differentiating myelopathies from radiculopathies.

High-yield summary

• Brown-Séquard Syndrome: Results from spinal cord hemisection (e.g., gunshot wound). Symptoms are ipsilateral loss of fine touch/vibration (Dorsal Columns) and contralateral loss of pain/temperature (Spinothalamic Tract), plus UMN signs on the same side as the lesion, and LMN signs at the level of the lesion.
• Central Cord Syndrome: Damage to the center of the spinal cord (e.g., cervical trauma, syringomyelia). Classically presents with bilateral loss of pain and temperature sensation in a "cape-like" distribution, often affecting the upper extremities more severely.
• Subacute Combined Degeneration: Caused by Vitamin B12 deficiency or impaired absorption (e.g., pernicious anemia, Crohn's disease). Affects both Dorsal Columns and Lateral Corticospinal Tract, leading to positive Romberg sign and UMN signs.
• Anterior Spinal Artery Syndrome: Damage to the anterior two-thirds of the cord (e.g., following triple Aneurysm repair). Results in loss of all functions except fine touch, vibration, and proprioception (Dorsal Columns are spared).
• Myelopathy vs. Radiculopathy: Myelopathy is a spinal cord problem; Radiculopathy is a nerve root problem. Myelopathies often present with bilateral symptoms or sensory levels; radiculopathies tend to be unilateral/lateral.
• ALS: A pure motor neuron disease (UMN + LMN) that never involves sensory deficits. Treatment targets glutamate excitotoxicity using Riluzole.

Learning objectives

• Differentiate the clinical presentations associated with various spinal cord syndromes (Brown-Séquard, Central Cord, Anterior Spinal Artery Syndrome).
• Recognize the specific neurological findings related to Vitamin B12 deficiency and its impact on dorsal columns and corticospinal tracts.
• Distinguish between myelopathy (spinal cord) and radiculopathy (nerve root) based on clinical patterns and physical exam findings.
• Identify the characteristic motor neuron deficits seen in primary lower motor neuron diseases (SMA, ALS).
• Interpret CSF findings associated with viral meningitis (e.g., West Nile Virus).