Spinal cord syndromes: complete, Brown-Séquard, central, anterior !

Syndrome

Patterns of weakness and sensory loss that show which part of the spinal cord is damaged.

Updated 2026-11-01

See it in 3D: Spinal cord · Grey matter of the cord · Anterior spinal artery · Conus medullaris · Cauda equina · Dorsal root ganglia

What it is

In the cord, each tract has a fixed place: the corticospinal and spinothalamic tracts in the lateral and anterior columns, and the vibration and position pathway in the dorsal columns. A lesion of one part of the cord therefore gives a recognisable mix of weakness and sensory loss. The key finding is the sensory level: below it sensation fails and upper motor neuron signs appear.

Key findings

Sensory level on the trunk: T4 nipple, T10 umbilicus, L1 groin.
New urinary retention or incontinence with back pain is a red flag.
Nursing: watch breathing in high cervical lesions, the bladder and pressure areas.

Pathophysiology

Corticospinal tract: lateral column, on the same side as the muscles it controls (it has already crossed in the medulla).
Spinothalamic tract: crosses in the cord one or two segments above its entry and ascends on the opposite side.
Dorsal columns: ascend on the same side and cross in the medulla.
The anterior spinal artery supplies the front two-thirds of the cord; the posterior spinal arteries, the dorsal columns.
The cord ends at about L1–L2 in the conus medullaris; below that there are only roots (cauda equina).

Spinal cord syndromes

Syndrome	Typical cause	Findings
Complete transection	Severe trauma, transverse myelitis, tumour compression	Loss of all strength and sensation below the level; bladder and bowel affected
Brown-Séquard (hemisection)	Penetrating wound, lateral compression	Same side: weakness and loss of vibration and position; opposite side: loss of pain and temperature
Central cord	Neck hyperextension with a narrow canal in older adults; syringomyelia	Arms weaker than legs; cape-like loss of pain and temperature
Anterior cord	Anterior spinal artery infarction (aortic surgery)	Weakness and loss of pain and temperature below the level; vibration and position spared
Posterior column	Vitamin B12 deficiency, tabes dorsalis	Loss of vibration and position, positive Romberg, sensory ataxia
Conus medullaris	Lesion at the L1 level	Saddle anaesthesia, early bladder and bowel involvement, mild distal weakness
Cauda equina (roots)	Large lumbar disc herniation, tumour, abscess	Radicular pain, saddle anaesthesia, urinary retention, leg areflexia

Common causes

Trauma: road accidents, falls, stab and gunshot wounds.
Compression: vertebral metastases, epidural abscess, disc herniation, cervical spondylosis.
Inflammation: multiple sclerosis, transverse myelitis.
Vascular: anterior spinal artery infarction.
Nutritional and infectious: vitamin B12 deficiency, tertiary syphilis, HTLV-1 myelopathy in endemic areas.

Tests that confirm it

Spinal MRI is the test of choice and is urgent when compression is suspected.
Vitamin B12 and syphilis serology for dorsal column lesions.

Test yourself

Think of the answer, then tap the question to see it.

What are the findings of Brown-Séquard syndrome?

Weakness and loss of vibration and position on the side of the lesion, with loss of pain and temperature on the opposite side below the level.

Which functions are spared in anterior cord syndrome?

Vibration and position sense, because the dorsal columns have a separate blood supply (the posterior spinal arteries).

Why does central cord syndrome affect the arms more?

The arm fibres lie in the innermost part of the corticospinal tract and cervical grey matter, the area most damaged.

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See it in 3D

The structures of Durgical's 3D anatomy where it is found.

← All of the clinical exam

Educational content on the clinical exam; it is learned and practised under supervision. It does not replace assessment by a health professional and is not for self-diagnosis.

Sources: Overview of Spinal Cord Disorders (MSD Manual Professional Edition, 2024); Spinal cord trauma (MedlinePlus, U.S. National Library of Medicine, 2024); 16.4 The Sensory and Motor Exams (OpenStax, Anatomy and Physiology 2e, 2022).

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Representative model, for educational purposes only.