Mechanical trauma of the spinal cord occurs in injuries in two phases: patient education should focus on smoking cessation and the development of a healthy lifestyle through exercise and good eating habits. If primary prevention fails and patients develop these risk factors, secondary prevention through additional lifestyle counseling as well as medical management is needed to keep these conditions in a well-controlled state. When patients develop umbilical cord infarction, continued strict treatment of these conditions can help prevent recurrence or continued functional decline. Ultimately, physiotherapy, occupational therapy and psychiatry play an essential role in restoring the patient`s functional autonomy in terms of motor function, social health and quality of life. [23] Due to the ischemic etiology of frontal cord syndrome, symptoms are usually acute. Patients have acute motor dysfunction, as well as loss of pain and a feeling of temperature below the level of the infarction. These symptoms are almost always bilateral, as both halves of the anterior spinal cord are fed by a midline of the anterior spinal artery. Depending on the location of the infarction, the severity of motor dysfunction usually varies from paraplegia to quadriplegia. Frontal cord syndrome begins with a closure of the blood supply or injury to the spine The human spine or spine is the main anatomical and functional axis of the human body. It consists of 7 cervical vertebrae, 12 thoracic vertebrae and 5 lumbar vertebrae and is cranially bounded by the skull and caudal by the sacrum. Spine: Anatomy. The syndrome is rarely due to the spinal cord The spinal cord is the main pathway that connects the brain to the body; it is part of the CNS. In cross-section, the spinal cord is divided into an H-shaped area of gray matter (consisting of synapsing neuronal cell bodies) and a surrounding area of white matter (consisting of ascending and descending pathways of myelinated axons).
Spinal cord: anatomical tumors. Ultimately, the underlying cause of frontal cord syndrome should be at the center of treatment; This may include surgery to correct an aortic dissection or immunosuppressive therapy to treat vasculitis. Once an umbilical spinal infarction has occurred, symptomatic treatment is also of paramount importance. This treatment could include fluid or pressure support for neurogenic hypotension, intubation and mechanical ventilation for elevated cervical infarctions that affect the diaphragm or bladder catheterization for neurogenic dysfunction. Anterior cord syndrome is often a serious, life-changing condition. It affects multiple organ systems throughout the body and therefore requires a team approach to provide optimal patient care. Emergency room providers must be able to quickly identify clinical signs and move to confirmatory imaging and treatment. Ragnarsson KT, Medical rehabilitation of people with spinal cord injuries during 40 years of academic physical practice.
American Journal of Physical Medicine [PubMed PMID: 22317933] MRI is the primary imaging modality in the diagnosis of anterior cord syndrome. T2 hyperintensities in the anterior horn region are the characteristic finding. These hyperintensities in sagittal vision appear as thin “pencil-shaped” lesions that extend vertically over several levels of the spine. In the axial view, these hyperintensities appear as two points of light, one in each front horn, resembling “owl eyes”. If imaging is obtained in the early stages of development, edema is present and can cause dilation of the spinal cord in the area of infarction. Sometimes signs of vertebral infarction can be identified near the area in question, increasing the specificity of imaging for umbilical spine infarction. [13] [14] [15] MRI is also used to exclude other causes of myelopathy, namely compressive pathologies. Vargas MI,Gariani J,Sztajzel R,Barnaure-Nachbar I,Delattre BM,Lovblad KO,Dietemann JL, Ischemia of the spinal cord: practical imaging tips, pearls and traps. AJNR. American Journal of Neuroradiology.
May 2015; [PubMed PMID: 25324492] The ventral two-thirds of the cord contain pathways essential for the proper functioning of the central nervous system (CNS); The violation negatively affects the effect of these leaflets. Damage to the efferent corticospinal tract leads to impaired motor function, while damage to the spinocerebellar and spinothalamic pathways leads to sensory deficits. Anterior spinal artery syndrome is the most common form of spinal cord infarction. [1] The anterior spinal cord has an increased risk of infarction because it is supplied by the single anterior spinal artery and has little collateral circulation, unlike the posterior spinal cord, which is supplied by two posterior spinal arteries. Central spinal cord syndrome is the most common form of incomplete spinal cord injury, characterized by impairment of the arms and hands and, to a lesser extent, the legs. The brain`s ability to send and receive signals to and from parts of the body below the site of injury is reduced, but not completely blocked. This syndrome is associated with damage to large nerve fibers that carry information directly from the cerebral cortex to the spinal cord. These nerves are especially important for the function of the hands and arms. Symptoms may include paralysis or loss of fine movement control in the arms and hands, with relatively less impaired leg movement. Sensory loss below the site of injury and loss of bladder control can also occur, as can painful sensations such as tingling, burning, or dull ache. The total amount and type of loss of function depends on the severity of nerve damage. Central cord syndrome is usually the result of trauma that causes damage to the cervical vertebrae or herniated discs.
It can also develop in people over the age of 50 due to progressive weakening of the vertebrae and intervertebral discs, which narrows the spine and can contribute to spinal cord compression if the neck is stretched too much. The prognosis for central cord syndrome varies, but most people whose syndrome is caused by trauma have some restoration of neurological function. Assessing abnormal signals on MRI images can help predict the likelihood that neurological recovery may occur naturally. Those who receive medical intervention soon after their injury often have good results. Many people with the disorder restore essential function after their initial injury, and the ability to walk is restored in most cases, although some impairments may persist. Improvement occurs first in the legs, then in the bladder and can be seen in the arms. The function of the hand recovers last, if at all. Recovery is generally better in younger patients than in patients over 50 years of age. Frontal cord syndrome usually consists of three main types of symptoms that can be affected: motor, sensory, and reflexive. It is considered an incomplete spinal cord injury, which means that the severity and loss of certain senses and functions may vary, and some sensations may remain intact. For example, a person who experiences a loss of motor function in the lower body may find that they are able to move one leg more than the other, or that there is a sensation in one area but not in another. People with anterior ligament syndrome are still able to feel vibrational sense and proprioception (an individual`s spatial awareness) because the dorsal spine remains intact when the anterior spinal artery is impaired.
The dorsal spine is the part of the spine that contains the function for these specific sensations. Physiotherapy and occupational therapy play an important prognostic role, helping the patient to rehabilitate and improve his functional motor state. The overall lifespan and functional independence of patients with spinal cord injuries has improved significantly over the years, and this is the result of improvements in various areas that have come together to improve patient care. [24] [Level 5] Treatment is determined by the root cause of frontal cord syndrome. If the diagnosis of frontal cord syndrome is made, the prognosis is unfortunate. The mortality rate is about 20%, with 50% of people with anterior cord syndrome having very little or no changes in symptoms. [1] In the atherothrombotic or embolic etiologies of frontal cord syndrome, thrombolysis is not yet considered a standard treatment. However, throughout the literature, several patients with acute umbilical cord ischemia were treated with intravenous thrombolysis within 4.5 hours of symptom onset, with neurological symptoms improving rapidly and no bleeding complications occurred. There is a theory that thrombolysis for this condition may be an effective treatment within a similar timeframe to stroke patients, but further safety and efficacy studies are needed. [18] Then, according to their clinical presentation, a subset of spinal cord injuries is divided into 6 spinal cord injury syndromes: central marrow syndrome (CCS), brown sequard syndrome (CSS), frontal cord syndrome (ACS), conus medullaris syndrome (CMS), cauda equina syndrome (CES) and posterior cord syndrome (DBS).