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Neurology Spinal Cord Pathology Advanced
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Spinal Cord Syndromes: Brown-Séquard vs Anterior Cord

SPINAL
CORD
CHEAT
SHEET
Localization cheat sheet for classic incomplete spinal cord injury syndromes.

Understanding decussation levels clarifies sensory and motor findings: Corticospinal tract (motor) and Dorsal columns (vibration/proprioception) decussate in the medulla (ipsilateral below lesion); Spinothalamic tract (pain/temp) decussates 1-2 levels above entry in cord (contralateral below lesion).

Systematic Breakdown

Brown-Séquard

Hemicord Lesion

Ipsilateral motor loss (corticospinal) + Ipsilateral loss of vibration/proprioception (dorsal column) + Contralateral loss of pain/temperature 1-2 levels below lesion (spinothalamic).

Anterior Cord

Anterior Spinal Artery Infarction

Bilateral motor loss (corticospinal) + Bilateral loss of pain and temperature (spinothalamic). DORSAL COLUMNS SPARED (proprioception and vibration intact).

Central Cord

Syringomyelia / Hyperextension Trauma

Bilateral 'cape-like' loss of pain and temperature over upper extremities (crossing spinothalamic fibers compressed in anterior white commissure). Upper extremities weaker than lower.

Posterior Cord

Tabes Dorsalis (Syphilis) / B12 Deficiency

Loss of vibration and proprioception, sensory ataxia, positive Romberg sign. Motor and pain/temperature preserved.

High-Yield Clinical Pearls & Exam Tips
  • Vitamin B12 deficiency (Subacute Combined Degeneration) damages BOTH the Dorsal Columns (proprioception) AND Lateral Corticospinal tracts (spastic paresis).
  • Anterior spinal artery occlusion spares the posterior 1/3 of the cord because posterior spinal arteries arise independently.
Related Pharmaceuticals
Methylprednisolone Cyanocobalamin (Vitamin B12)
Related Clinical Conditions
Brown-Séquard Syndrome Syringomyelia Subacute Combined Degeneration Tabes Dorsalis
Authoritative Sources: Adams and Victor's Principles of Neurology 11e · First Aid USMLE Step 1

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