What is consistent with an anterior cord syndrome?

Anterior Cord Syndrome: Clinical Characteristics and Diagnosis

Loss of pain, temperature, and motor function is consistent with an anterior cord syndrome.

Pathophysiology and Clinical Presentation

Anterior cord syndrome results from damage to the anterior two-thirds of the spinal cord, typically due to:

• Ischemia from anterior spinal artery compromise
• Direct compression of the anterior spinal cord
• Traumatic or non-traumatic causes

The clinical presentation reflects the specific neuroanatomical structures affected:

• Motor function: Loss occurs due to damage to the corticospinal tracts
• Pain and temperature sensation: Loss occurs due to damage to the spinothalamic tracts
• Preserved functions: Vibration sense and proprioception remain intact due to preservation of the posterior columns 1

Differential Diagnosis Among Cord Syndromes

When evaluating a patient with suspected spinal cord injury, it's important to distinguish between different cord syndromes:

1. Anterior Cord Syndrome:

   • Loss of motor function below the level of injury
   • Loss of pain and temperature sensation below the level of injury
   • Preservation of vibration sense and proprioception 2, 3

2. Central Cord Syndrome:

   • Upper extremity weakness greater than lower extremity weakness
   • Variable sensory loss
   • Often seen in hyperextension injuries, especially in the cervical region 4

3. Complete Spinal Cord Injury:

   • Loss of all motor and sensory function below the level of injury
   • No preservation of function in the sacral segments

4. Brown-Séquard Syndrome (not in the options):

   • Ipsilateral motor weakness and proprioception loss
   • Contralateral pain and temperature loss

Diagnostic Approach

MRI is the preferred imaging modality for suspected anterior cord syndrome:

• Allows visualization of the spinal cord parenchyma
• Can identify ischemic changes, compression, or other pathologies
• Should be performed urgently in cases of suspected spinal cord injury 1

Etiology and Prognosis

The etiology of anterior cord syndrome significantly affects prognosis:

• Unknown causes: 92.9% motor recovery
• Post-infection or vaccination: 88.9% motor recovery
• Anterior spinal artery occlusion: 33.3% motor recovery
• Spinal cord angioma: 20% motor recovery
• Aortic lesion: 20% motor recovery 2

Patients with partial preservation of motor function or pain sensation below the lesion have better outcomes than those with complete loss of both functions 2.

Clinical Pearls and Pitfalls

• Anterior cord syndrome can present without a history of trauma, as seen in cases of hypotension-related hypoperfusion of the anterior spinal artery 3
• The syndrome can be transient or intermittent in some cases 3
• Pediatric cases may present with atypical patterns of recovery that don't follow the classic proximal-to-distal pattern 4
• Prompt recognition and management are essential to improve outcomes

Understanding the specific pattern of neurological deficits is crucial for accurate diagnosis and appropriate management of anterior cord syndrome.