An anterior cord syndrome is most commonly caused by which vascular event?

• A. Anterior spinal artery stroke.
• B. Demyelination of dorsal columns.
• C. Posterior spinal artery stroke.
• D. Peripheral nerve injury.

Answer: (A)

Anterior cord syndrome results from ischemia of the front two-thirds of the spinal cord, which disrupts the corticospinal and spinothalamic tracts as well as the anterior horn cells while sparing the dorsal columns that carry vibration, fine touch, and proprioception. The artery that supplies this region is the anterior spinal artery, so an occlusion or stroke of that artery is the classic vascular event causing this syndrome. Clinically, this means weakness or paralysis and loss of pain and temperature sensation below the level of the lesion, with preserved vibration and position sense. Demyelination of the dorsal columns would mainly affect vibration and proprioception; a posterior spinal artery stroke would primarily impair dorsal column functions; peripheral nerve injury would not produce the bilateral central pattern seen in anterior cord syndrome.