Incomplete Spinal Cord Syndromes

AUTONOMIC IMPAIRMENT

In addition to its somatic components, the spinal cord also contains autonomic nerve fibers, carried in the intermediolateral columns. A lesion at any level may cause sphincter dysfunction. Spinal cord lesions may damage the upper motor neuron pathways that control the bladder and rectum, but incontinence does not develop unless there is a severe bilateral lesion.

Other signs of autonomic dysfunction include erectile dysfunction in men; changes in sweating, with anhidrosis below the level of the lesion; and Horner syndrome, which includes ipsilateral miosis, ptosis, and decreased facial sweating secondary to damage to sympathetic fibers at C8-T1. A variety of gastrointestinal disturbances may also occur.

OTHER ABNORMALITIES

Café au lait spots may suggest the presence of a meningioma or a neurofibroma. A tuft of hair or dimple in the midline, particularly in the lower spine, may point to an underlying congenital vertebral defect. In rare cases, a cutaneous angioma may overlie or be segmentally related to a spinal cord or dural arteriovenous fistula.

Although scoliosis is usually idiopathic, it rarely is the first sign of an evolving spinal cord tumor. Pes cavus may be seen with distal spinal cord lesions. A short neck may suggest the Klippel-Feil syndrome, which is sometimes associated with other cervical spine lesions.

Spinal cord dysfunction can be identified early if the patient’s history and the results of neurologic examination are carefully assessed, with particular attention to the distribution of motor, reflex, and sensory changes associated with autonomic dysfunction and the presence of various skeletal and cutaneous changes.

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