]> 2026-07-31T11:51:53+00:00 WBR1505 0 en Central cord syndrome Central cord syndrome is defined as injury to the central portion of the spinal cord. It is typically caused by hyperextension injuries in the cervical spine (eg whiplash). It typically causes weakness in a cape-like distribution along the upper extremities. Transverse myelitis Tabes dorsalis Anterior cord syndrome Anterior cord syndrome is caused by injury to the anterior part of the spinal cord. These lesions typically affect the corticospinal tract and the spinothalamic tract. Therefore, patients frequently have paralysis and loss of pain/temperature below the level of the lesion. Because proprioception and vibration travel in the posterior aspect of the spinal cord, they are unaffected. Cauda equina syndrome Cauda equina syndrome is caused by the compression of the nerve roots that leave the lumbosacral spinal cord in the cauda equina. These patients typically have saddle anesthesia, bowel/bladder dysfunction and sciatica-like pain. The imaging in this patient demonstrates a lesion in the thoracic vertebrae. The lumbosacral spine is not pictured. The patient in this vignette has transverse myelitis. She has symptoms of an upper motor neuron lesion (hyperreflexia) in both lower extremities. Her CNS insult is therefore either in the spine or the brain.<br/> '''Educational Objective:''' <br/> '''References:''' Internal medicine William J Gibson A 58 year old woman presents to the hospital for bilateral lower extremity leg cramps, paresthesias, and lower extremity weakness (right greater than left). She reports the symptoms occurred gradually over the course of two days. On admission, she is found to have urinary retention and a foley catheter is inserted. On physical exam she is afebrile, and her mental status is normal. She has symmetric 2+ reflexes in the lower extremities. Proprioception and sensation to vibration are diminished bilaterally in the lower extremities. The patient reports a general feeling of numbness below the umbilicus. She is unable to stand or ambulate on her own. The results of T2 spinal MRI are shown below. A lumbar puncture is performed, which demonstrates total protein of 141 mg/dL, glucose of 80 mg/dL and 13 WBC/mL. <br> <img src="https://upload.wikimedia.org/wikipedia/commons/thumb/d/de/Transverse_myelitis_MRI.jpg/550px-Transverse_myelitis_MRI.jpg"> <br> What is the most likely diagnosis? B Neurology 2020-10-28T02:47:53Z 2459150.6165857 WBR1505