Anterior cord syndrome is most commonly due to which event?

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

Answer: (A)

Anterior cord syndrome happens when the anterior two-thirds of the spinal cord lose blood supply, most often from an ischemic event affecting the anterior spinal artery. This pattern damages the corticospinal tract and the spinothalamic tract, causing bilateral weakness and loss of pain and temperature sensation below the level of the injury. The dorsal columns, which carry vibration and proprioception, are spared because they’re supplied mainly by the posterior spinal arteries. That’s why an anterior spinal artery stroke is the best explanation. The other options describe conditions that affect different parts or modalities (dorsal column demyelination, posterior cord syndrome, or peripheral nerve injury) and wouldn’t produce this specific combination of deficits.