Local and regional anaesthesia: anterior spinal artery syndrome: practice question

A Anaesthesia question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Anaesthesia · Local and regional anaesthesia: anterior spinal artery syndrome

Sample item

After prolonged hypotension during aortic aneurysm repair with a thoracic epidural, a patient wakes with flaccid paralysis of both legs and loss of pain and temperature below the umbilicus. Vibration and joint position sense are preserved. What is the most likely diagnosis?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Anterior spinal artery syndrome

The anterior spinal artery supplies the anterior two-thirds of the cord, including the corticospinal and spinothalamic tracts. Ischaemia from hypotension or aortic cross-clamping causes motor loss and loss of pain and temperature with preserved dorsal column function. An epidural haematoma should still be excluded by urgent imaging.

Option by option

  • A. Brown-Sequard syndrome

    Brown-Sequard syndrome is a hemisection with ipsilateral motor loss and contralateral pain loss.

  • B. Central cord syndrome

    Central cord syndrome mainly weakens the arms more than the legs and affects the cervical cord.

  • C. Anterior spinal artery syndrome (correct)

    Correct. Anterior cord ischaemia spares the dorsal columns, giving this dissociated loss.

  • D. Posterior cord infarction

    A posterior infarct would impair vibration and position sense, which are preserved here.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Anaesthesia question

What is the answer to this Anaesthesia question?

The best answer is C, Anterior spinal artery syndrome. The anterior spinal artery supplies the anterior two-thirds of the cord, including the corticospinal and spinothalamic tracts.

Why is "Brown-Sequard syndrome" not the answer?

Brown-Sequard syndrome is a hemisection with ipsilateral motor loss and contralateral pain loss.

Why is "Central cord syndrome" not the answer?

Central cord syndrome mainly weakens the arms more than the legs and affects the cervical cord.

Why is "Posterior cord infarction" not the answer?

A posterior infarct would impair vibration and position sense, which are preserved here.

What concept does this question test?

It tests Local and regional anaesthesia: anterior spinal artery syndrome in Anaesthesia. Ischaemia from hypotension or aortic cross-clamping causes motor loss and loss of pain and temperature with preserved dorsal column function. An epidural haematoma should still be excluded by urgent imaging.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Local and regional anaesthesia: anterior spinal artery syndrome?

Make a table of each agent, its key advantage and its main side effect. Then use the flashcards and the other Anaesthesia questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.