Atypical syndromes caudal to the injury site in patients following spinal cord injury. A clinical, neurophysiological and MRI study.

Some patients with a cervical or a high thoracic spinal cord injury show atypical signs and symptoms such as atrophy of lower leg muscles, reduced tendon jerks or urinary retention, either persisting from the acute phase or developing in the course of time. A series of 35 patients was prospectively examined from this point of view with neurophysiological, urodynamic and MRI studies. Seven patients (20%) presented atypical findings; in two there was an isolated areflexic bladder, but no signs of functional or structural sacral damage were found. In five patients (14.2%) a definite cause for the sacral lesion could be detected. The syndrome caudal to the level of the lesion is neither obvious at the beginning nor immutable in time. Treatment requires to be adapted to the changing patterns of somatic and visceral activity.