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# 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](https://durgical.com/en/anatomy/spinal-cord/) · [Grey matter of the cord](https://durgical.com/en/anatomy/grey-matter-of-spinal-cord/) · [Anterior spinal artery](https://durgical.com/en/anatomy/anterior-spinal-artery/) · [Conus medullaris](https://durgical.com/en/anatomy/conus-medullaris/) · [Cauda equina](https://durgical.com/en/anatomy/cauda-equina/) · [Dorsal root ganglia](https://durgical.com/en/anatomy/spinal-ganglion/)

## Key points

- Brown-Séquard: weakness and loss of vibration on the same side; loss of pain and temperature on the opposite side.
- Central cord: arms weaker than legs; the most common incomplete syndrome, after neck hyperextension in older adults.
- Anterior cord: anterior spinal artery infarction; only vibration and position are spared.
- Conus medullaris and cauda equina: saddle anaesthesia and urinary retention; surgical emergencies when there is compression.
- Spinal shock: flaccidity and areflexia at first; later spasticity, hyperreflexia and Babinski.

## 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](https://durgical.com/en/conditions/spinal-cord-injury/) | 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](https://durgical.com/en/conditions/degenerative-cervical-myelopathy/) | 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](https://durgical.com/en/conditions/megaloblastic-anaemia/) | 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)](https://durgical.com/en/conditions/cauda-equina-syndrome/) | 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.

[Add to my cards (3)](https://durgical.app/estudiar/?add=/en/clinical-exam/spinal-cord-syndromes-complete-brown-sequard-central-anterior/)

## See it in 3D

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

- [Spinal cord](https://durgical.com/en/anatomy/spinal-cord/)
- [Grey matter of the cord](https://durgical.com/en/anatomy/grey-matter-of-spinal-cord/)
- [Anterior spinal artery](https://durgical.com/en/anatomy/anterior-spinal-artery/)
- [Conus medullaris](https://durgical.com/en/anatomy/conus-medullaris/)
- [Cauda equina](https://durgical.com/en/anatomy/cauda-equina/)
- [Dorsal root ganglia](https://durgical.com/en/anatomy/spinal-ganglion/)

## Related

- [Sensory examination: modalities and dermatomes](https://durgical.com/en/clinical-exam/sensory-examination-modalities-and-dermatomes/)
- [Upper vs lower motor neuron syndrome](https://durgical.com/en/clinical-exam/upper-vs-lower-motor-neuron-syndrome/)
- [Deep tendon reflexes and their grading](https://durgical.com/en/clinical-exam/deep-tendon-reflexes-and-their-grading/)
- [Hoffmann sign and clonus](https://durgical.com/en/clinical-exam/hoffmann-sign-and-clonus/)
- [Babinski sign](https://durgical.com/en/clinical-exam/babinski-sign/)

## Related conditions

- [Spinal cord injury](https://durgical.com/en/conditions/spinal-cord-injury/)
- [Cauda equina syndrome](https://durgical.com/en/conditions/cauda-equina-syndrome/)
- [Degenerative cervical myelopathy](https://durgical.com/en/conditions/degenerative-cervical-myelopathy/)
- [Multiple sclerosis](https://durgical.com/en/conditions/multiple-sclerosis/)
- [Spinal epidural abscess](https://durgical.com/en/conditions/spinal-epidural-abscess/)
- [Megaloblastic anaemia (B12 or folate deficiency)](https://durgical.com/en/conditions/megaloblastic-anaemia/)

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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](https://www.msdmanuals.com/professional/neurologic-disorders/spinal-cord-disorders/overview-of-spinal-cord-disorders) (MSD Manual Professional Edition, 2024); [Spinal cord trauma](https://medlineplus.gov/ency/article/001066.htm) (MedlinePlus, U.S. National Library of Medicine, 2024); [16.4 The Sensory and Motor Exams](https://openstax.org/books/anatomy-and-physiology-2e/pages/16-4-the-sensory-and-motor-exams) (OpenStax, Anatomy and Physiology 2e, 2022).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/clinical-exam/spinal-cord-syndromes-complete-brown-sequard-central-anterior/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/clinical-exam/spinal-cord-syndromes-complete-brown-sequard-central-anterior/