Anterior cord syndrome below the level of injury presents with which type of motor signs?

• A. Lower motor neuron signs
• B. Upper motor neuron signs
• C. Mixed signs
• D. No motor signs

Answer: (B)

The key idea is how spinal cord injuries affect motor pathways. Anterior cord syndrome damages the corticospinal tract, which carries voluntary motor commands. When these tracts are interrupted below the level of injury, the result is upper motor neuron signs in the tissues below the lesion—spastic weakness, increased tone, hyperreflexia, and a positive Babinski sign. At the actual level of injury, there may be some lower motor neuron involvement due to damage to the anterior horn cells, causing flaccid paralysis there, but below the lesion the dominant pattern is UMN signs. In this syndrome the dorsal columns are often spared, so fine touch and proprioception remain intact below the level of injury.