Spinal cord lesions

Lesions in the spinal cord produce a combination of segmental and long tract (longitudinal) signs.

Segmental signs are related to:

Lesions of the anterior root or anterior horn cell giving rise to a myotomal distribution of flaccid weakness, atrophy and fasciculations;

Lesions of the dorsal root or dorsal root entry zone giving rise to a dermatomal distribution of sensory loss;

Loss of reflex function, caused by disruption of the mono-synaptic stretch reflex arc;

Dermatomal pain from dorsal root irritation.

Longitudinal signs comprise:

Upper motor neuron lesions characterised by spastic weakness, hyper-reflexia, clonus, extensor plantar responses and loss of superficial cutaneous reflexes (abdominal and cremasteric);

Sensory loss below a sensory level.

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