CHAPTER 23
SYMPTOMATOLOGY
A. COMPLETE TRANSVERSE SPINAL SYNDROMES
AT DIFFERENT LEVELS
HIGH THORACIC AND CERVICAL LESIONS
Certain symptoms are common to all complete cervical and upper thoracic lesions. These
are:
1
Areflexia or hyporeflexia of both motor and autonomic systems during the stage of
spinal shock;
2 Hyperreflexia of skeletal muscles in later stage;
3
Postural hypotension;
4 Automatic bladder and bowel function;
5 Autonomic hyperreflexia due to visceral distension and visceral hyperactivity.
UPPER CERVICAL SEGMENTS, CI-C4
Traumatic lesions of the upper cervical cord following fracture-dislocations of the atlas
or epistropheus may be confined solely to Ci-C4 segments, while, on the other hand,
pathological processes such as tumours originating from these segments may ascend and
involve also cranial nerves of the oblongata. Conversely, tumours originating at the level
of the foramen magnum may first manifest themselves by the symptomatology of upper
cervical cord compression. Pain in the neck and occipital region, intensified by movements
of the head, combined with paraesthesia over the C2 distribution and followed by para-
esthesia such as sensation of intense cold and spastic weakness of the upper and lower
limbs, either unilaterally or bilaterally, are early symptoms of such a cord involvement
(Naffziger & Brown, 1933; Symonds & Meadows, 1937; Bennett & Fortes, 1945).
Involvement of one or both vertebral arteries may lead to disturbances of their distal
branches, resulting in atrophy of muscles of the forearm and hand and thus simulating
amyothrophic lateral sclerosis. Involvement of the unilateral spinal trigeminal tract may
cause sensory disturbances in the face of lamelliform type. Tapping of occiput or mastoid
process may produce reflex contractions to greater or lesser degree of the upper cervical
muscles (trapezius and sternomastoid).
In complete transverse syndromes of the upper cervical segments, splenius capitis,
recti and obliqui, sternohyoideus, geniohyoideus, and thyreohyoideus are paralysed, and
only trapezius, sternomastoid and platysma are still acting owing to their innervation by
the accessory and facial nerves respectively. The greatest complication in traumatic
lesions is the paralysis of the diaphragm resulting from the interruption of the segmental
innervation of the phrenic nerve. As all other respiratory muscles below the transection
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