The anterior cord syndrome

– Complete paralysis below the level of the lesion due to interruption of the corticospinal tract

– Loss of pain and temperature sensation at and below the level of the lesion due to interruption of the spinothalamic tract

– Retained proprioception and vibratory sensation due to intact dorsal columns

– Areflexia, flaccid anal sphincter, urinary retention and ileus

Causes:

– spinal cord infarct secondary to occlusion of the arterial branches that supply the anterior spinal artery – aortic aneurysm / dissection, direct trauma to the aorta, aortic surgery, arteritis, arterial emboli / decompression sickness, direct vascular injury (trauma or iatrogenic), polycythemia, sickle cell disease, decompression sickness, cocaine use, collagen and elastin disorders

– trauma or acute disc herniation

– malignancy + anterior cord compression

Immediate complications:

– respiratory distress – respiratory failure

– spinal shock due to loss of the sympathetic tone if level is above T4