Medullary syndromes: types, causes and symptoms
Within the human organism is the spinal cord, an extensive cord that is responsible for transport nerve impulses from the brain to the rest of the body and vice versa . Thanks to her we can make any movement, stand up or perceive all kinds of sensations, both internal and external.
However, when it is injured or suffer some kind of pathology Medullary syndromes or myelopathies appear . The term of spinal syndromes groups together a variety of marrow affections with consequences that affect both motor skills and sensory abilities.
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What are spinal syndromes?
Medullary syndromes, or diseases of the spinal cord, refer to a diverse set of symptoms and signs that may vary depending on the location of the spinal cord injury .
Although these conditions do not usually occur very frequently, they tend to cause serious effects and consequences on the person's health, leading, in many cases, some type of disability .
This is the reason why a hasty diagnosis of these spinal syndromes, as well as an effective therapeutic intervention, is essential to diminish or compensate in the best way the symptoms of these conditions.
We can distinguish several types of spinal syndromes based on the symptoms that each one of them presents. These symptoms are associated with specific etiological processes; that is, to the causes that have caused the damage or injury. These damages can affect the entire medullary cylinder or, on the contrary, damage only a part of the cord in its cross section.
At the moment in which the medical professional has to make the diagnosis of one of these spinal syndromes, must take into account the possibility that it is any of the conditions, such as some autoimmune, muscular or psychiatric diseases, which have a symptomatology Similary. An exhaustive differential diagnosis will be the key to be able to carry out a satisfactory treatment of the patient .
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Types of spinal syndromes
As mentioned above, there is a great variety of classic spinal syndromes. The main way to classify them is by taking into account their symptoms, as well as the temporal pattern of these.
1. Complete spinal cord injury
In those cases of complete spinal cord injury, or transverse myelopathy, the person will experience the disappearance of all sensory modalities , as well as a bilateral alteration of the motor pathways that are below the lesion.
This syndrome is characterized by presenting sensory symptoms and motor symptoms. The sensory symptoms of a complete spinal cord injury are:
- Paresthesias or abnormal sensations of tingling and changes in body temperature. These sensations are given in the section that corresponds to the level of the injury.
- Pain located in the vertebrae .
- Root pain according to the location of the lesions. If it is a cervical injury, the person will experience pain in the arms, while if it is thoracic or lumbar, the pain will focus on the thorax and abdomen or legs.
- Low sensory threshold or loss of all sensory modalities.
On the other hand, symptoms related to motor functions include:
- Lesions in the lower motor neurons that cause muscle atrophy, fasciculations or small muscle contractions that can be observed under the skin and hyporeflexia or decreased reflex response.
- Paraparesis / paraplegia or tetraparesis / tetraplegia . The person experiences paralysis or mobility problems, both of varying degree, in the lower extremities or in all four extremities.
2. Incomplete spinal cord injury
In cases of incomplete syndromes or spinal cord injuries, the spinal cord is not completely damaged at the transverse level , so that the person does not experience a total paralysis, nor a total loss of sensitivity.
Likewise, there are several types of incomplete spinal cord injuries that differ according to the set of symptoms they cause.
Medullary hemisection or Brown-Séquard syndrome
In this case the person suffers an alteration or damage in the hemimédula . However, it is very complicated that this lesion is just in the median line of the cord or that it appears purely unilaterally.
Spinal cord hemisection may be caused by some type of infection or injury at that particular point. Likewise, certain tumor bodies or degenerative diseases They can also cause this type of syndrome.
The symptoms typical of this condition usually appear at the ipsilateral level and below the level of the lesion, the most important being the paralysis of the first homolateral motor neuron and the lack of sensitivity to pain and temperature.
Symptoms of spinal cord hemisection include:
- Ioslateral paralysis.
- Thermoanalgesia or insensitivity to contralateral temperature.
- Muscle weakness and paralysis .
- Loss or diminution of sensibility and sensory perception.
- Alterations in the perception of posture and position (proprioceptive system).
Centromedullary syndrome
In the condition of the medullary type, the damage is found in the central gray matter and in the spinothalamic tracts that cross the central area of the medulla. In addition, this lesion can dissipate in a centrifugal way affecting other anatomical pathways.
Among the sensitive symptoms we find a loss of sensitivity to pain and temperature . While at motor level the person can experience muscle atrophy, fasciculations, muscle weakness and hyporeflexia.
Combined lesion of posterior and lateral cords
In this type of injury the person can experience motor symptoms such as muscle weakness, constant muscular spasticity or contraction, hyperreflexia and Babinski reflex, which consists of the dorsal extension of the big toe.
At a sensitive level, symptoms include alterations in the proprioceptive system and sensitivity to vibration .
Isolated lesion of posterior cords
In this case the damage is caused only in certain cords or posterior fibers. This injury causes an alteration of the proprioceptive and vibratory sensibility in the person, as well as ataxia or difficulties in the coordination of the movements. In addition, the person You may also experience a throbbing pain in your legs and urinary incontinence .
Previous antlers syndrome
In comparison with the rest of the ailments, in the anterior horns syndrome, only pure motor symptoms appear, typical of an atrophy in the second motor neuron. These symptoms include fasciculations, muscle weakness, hypotonia and hyporeflexia in one or several muscle groups. In addition, it also causes absence of reflexes.
Pyramidal and anterior horn syndrome combined
In this last syndrome of incomplete medullary nature, also only motor symptoms appear ; with the difference that symptoms of the first and second motor neurons develop simultaneously within the same muscle group. The cause is an anomaly present in the pyramidal tracts and in the previous horns.
3. Medullary vascular syndromes
Unlike the syndromes typical of complete and incomplete spinal cord injuries, in the spinal cord syndromes the origin of the anomaly is found in an anomaly of blood flow in any area of the medulla .
Medullary arterial ischemia syndromes
In this case, the suspension of arterial blood supply in the spinal cord has the direct result of the occurrence of stroke or transient ischemic accidents.
Medullary venous ischemia syndrome
This type of syndromes are much more infrequent than the previous ones. Further, tend to affect the lower extremities , producing bilateral syndromes or complete transverse syndromes almost always asymmetrically.
The main causes of this type of pathologies are arteriovenous malformations, fibrocartilaginous emboli and the effects of decompression.
Medullary hemorrhage syndromes
In these syndromes we can differentiate between intramedullary hemorrhage and extramedullary hemorrhage . The intramedullary is produced by a vascular rupture causing spinal pain, paresis and sensory alterations below the level of the lesion.
As for extramedullary hemorrhage, this is much more infrequent. In this case the person experiences an acute spinal pain in the place where the effusion is found, together with symptoms similar to those of a cerebral subarachnoid hemorrhage. Among those that include numbness in one part of the body, cervical tension seizures, vision problems, nausea or muscle aches.
