Following trauma to the spine, there is complete paralysis in the legs with loss of temperature and pain sensation, but preserved proprioception and vibratory sense. Dx?

• A. Central Cord Syndrome
• B. Brown-Sequard Syndrome
• C. Anterior Cord Syndrome
• D. Posterior Cord Syndrome

Answer: (C)

This scenario tests how spinal cord tracts produce specific loss of function after injury. Anterior cord syndrome occurs when the anterior two-thirds of the cord are damaged, often from injury to the anterior spinal artery. In this pattern, the corticospinal tracts are disrupted, so there is bilateral paralysis below the level of injury. The spinothalamic tracts are also affected, leading to loss of pain and temperature sensation below the lesion. Meanwhile, the dorsal columns, which carry proprioception and vibratory sense, are spared, so position sense and vibration remain intact.

So the combination of complete leg paralysis with loss of pain and temperature, but preserved proprioception and vibration, is classic for anterior cord syndrome, matching the described trauma. By contrast, central cord syndrome typically shows greater weakness in the upper extremities; Brown-Sequard has ipsilateral motor loss with loss of vibration/proprioception and contralateral pain/temperature loss; posterior cord syndrome would mainly disrupt proprioception and vibration with preserved motor and pain/temperature.