Posterior spinal cord syndrome

Causes

• Ischemia
  • Aortic pathology (dissection, aneurysm, thrombosis, iatrogenic injury)
  • Anterior spinal artery dissection (traumatic, iatrogenic) due to ischemia in collaterals or watershed infarction in the posterior cord
  • Fibrocartilaginous embolism from intervertebral disk
  • Cholesterol embolism
  • Vasculitis
  • Hypertensive small vessel disease
  • Sickle cell anemia
  • SLE
  • Atrial myxoma
  • Intra-aortic balloon pump
  • Lumbar artery compression
• Disk herniation
• Neoplasm
• Penetrating trauma
• Spinal fracture dislocation
• Epidural abscess or hematoma
• Carcinomatous meningitis
• Subarachnoid hemorrhage
• Thoracotomy and thoracoplasty
• Esophageal surgery
• Lumbar sympathectomy
• Celiac plexus block

Clinical presentation

• Loss of proprioception and vibration sensation
• Preserved pain and temperature sensation
• Loss of reflexes below involved segments
• Intact motor function in pure posterior spinal cord syndrome
• Focal motor and/or sensory deficits in extremities might represent lacunar spinal cord infarcts
• Slowly progressive para- or quadriparesis in hypoxic myelopathy
• Spinal cord claudication in hemodynamic transient ischemic attacs