244 Mechtler & Nandigam

the more common neoplastic cause of this syndrome; but intramedullary astrocy-
tomas, gangliogliomas, hemangioblastomas, and metastases9 may cause similar
findings.

Ventral Cord Syndrome

The clinical presentation of ventral spinal cord syndrome includes complete motor
paralysis below the level of the lesion caused by the interruption of the corticospinal
tracts, with a loss of pain and temperature sensation below the level of the lesion
caused by the interruption of the spinothalamic tract. There is sparing of propriocep-
tion and vibratory sensation caused by intact dorsal columns. Flaccid anal sphincter,
urinary retention, and intestinal obstruction may be associated with anterior cord
syndrome. The most common causes of anterior spinal cord syndrome include occlu-
sion or dissection of the anterior spinal artery. An acute disk herniation, cervical spon-
dylosis, vasculitis, and sickle cell disease are also associated with this syndrome.
Anterior epidural metastatic disease is the most common neoplastic cause. Rare
neuro-oncological causes include radiation myelopathy, and astrocytoma is also in
the differential diagnosis.10

Central Cord Syndrome

Central cord syndrome occurs when a lesion affects the center of the spinal canal,
mainly the central gray matter and adjacent crossing spinothalamic tracts, causing
paresis in the upper extremities more than the lower extremities. There is a loss of
pain and temperature sensation in a shawl-like distribution over the upper neck, shoul-
ders, and upper trunk, with light touch, position, and vibratory sensation relatively
preserved (disassociated sensory loss). There are usually no bladder symptoms.
The classic causes of central cord syndrome are slow-growing lesions, such as syrin-
gomyelia, or intramedullary tumors, such as ependymomas. However, central cord
syndrome is also seen in patients with hyperextension injury and longstanding cervical
spondylosis.11

Dorsal Cord Syndrome

Dorsal cord syndrome results from bilateral involvement of the dorsal columns, the
corticospinal tracts, and descending central autonomic tracts. The main symptoms
of dorsal column syndrome include gait ataxia, paresthesias, weakness, and bladder
control symptoms. Lhermitte sign often occurs in patients with posterior column
involvement, especially in the cervical spine,12,13 which is characterized by a sensation
of electrical shocks running down the spine and into the limbs, occurring with bending
the head forward or backward. The causes of dorsal cord syndrome include multiple
sclerosis, tabes dorsalis, subacute combined degeneration, compressive myelopathy
caused by cervical spondylitic disease, as well as epidural and intradural extramedul-
lary tumors, and radiation myelopathy.10

Conus Medullaris Syndrome

Conus medullaris syndrome in its pure form presents with sphincter disturbances,
saddle anesthesia (S3S5), impotence, and the absence of lower extremity abnormal-
ities. Lower extremity weakness tends to be mild, and spontaneous pain tends to be
bilateral and symmetric. The causes of conus medullaris syndrome include disk herni-
ation as well as the following neoplasms: myxopapillary ependymomas, lymphomas,
and astrocytomas.