Spinal Cord

Complete transection Brown-Sequard

C1-C4 - Flaccid paralysis of diaphragm (dyspnea), radix of C4 -
-
Ipsilateral central paralysis
Ipsilateral deep sensation
- Central paralysis of extremities (tetraplegia) - Urination normal
- Loss of all kinds of sensation
- Central (suprasegmental) disturbances of urination
- Radicular pains in the neck to the nape
C5-T2 (zone of - Peripheral paralysis of upper extremities (peripheral Left part
innervation of
upper extremities)
paraplegia) - Ipsilateral peripheral of upper
- Central paralysis lower extremities (central paraplegia) extremities

- Loss of all kinds of sensation below level of lesions

- Ipsilateral central paralysis of
E.g. cervical lower extremities
spondyulosis - Central (suprasegmental) disturbance of urination.
- Ipsilateral deep sensation
- Radicular pains irradiating in upper extremities.
- Contralateral superficial sensation
(radiculopathy)
- Horners syndrome
- Urination normal
T3-T10 - Upper extremities are unaffected Right side

- Central paralysis of lower extremities (paraplegia)

- Upper extremities normal

- Loss of all kinds of sensation below level of lesions

- Ipsilateral central paralysis of leg

- Central (suprasegmental) disturbance of urination, usually

- Ipsilateral deep sensation
acute urinary retention - Contralateral superficial sensation
- Radicular pains have surrounding character. - Urination normal
L1-S2 (zone of - Peripheral paralysis of lower extremities (paraplegia) Left side
innervation of
lower extremities) - Loss of all kind sensation below level of lesions and in
- Ipsilateral peripheral paralysis
perineum - Urination normal
- Central (suprasegmental) disturbance of urination - Ipsilateral deep sensation
- Contralateral superficial sensation
Conus medullaris
(S3-S5)
- Paralyses are absent
- Loss of sensation in the field of a perineum (saddle- -
e.g. tumor, anesthesia)
ischemia, lumbar
disc herniation
- Peripheral (segmental) disturbances of urination
- Impotence and loss of anal reflex
Cauda equine
(involve fibers of
- Peripheral paralysis of the lower extremities (paraplegia)
L1,L2 and below) - Loss of all type of sensation on the lower extremities and in
a perineum -
- Peripheral (segmental) disturbances of urination
- Impotence and loss of anal reflex
- Severe radicular onychalgias (bladder pain worsen by
coughibg or sneezing)
- In lower cauda equine lesions (pseudo-conducting):
No paralysis of extremities
Saddle anesthesia
Urination, defecation and sexual dysfunction
5 variants of urination
disturbances
- Centrum vesicospinale and anospinale: located at level S3-S5 in grey substance the spinal centers of urination and defecation
- Their automatic reflex activity in normal adult is regulated to certain extent by cortex of brain via lateral columns (bilateral control, in frontal lobe). In unilateral lesion of
lateral column, communications with cortex are preserved, and disturbances of urination and defecation are not observed.
- 2 main groups
1. Suprasegmental (cental) disturbances
a. Incontinentio intermittens (periodic): Cortical regulation of urination is absent automatic reflex type of urination (independent activity of the spinal centers).
Usually observed in children.
b. Imperative incontinence
c. Urinary retention (retention urinae): marked in first few days of complete trasection of spinal cord when process develops acutely (trauma, inflammation) and
later is replaced by periodic incontinence.

2. Segmental (peripheral) disturbances

a. Incontinentio vera (true incontinence): typical in conus medullaris lesions. Urine is continuously allocated on drops in process of its entering into bladder, not
collecting in the bladder.
b. Ischuria paradoxa: hypertonicity of neck of the bladder remains cause resistance to pressure of urine and urine start to collect in bladder leads to over flown of
bladder urine is allocated on drops