Central Cord Syndrome

Aka: Central Cord Syndrome, Central Spinal Cord Syndrome

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II. Epidemiology

  1. Most common Partial Cord Syndrome

III. Pathophysiology

  1. Hyperextension of the Cervical Spine (e.g. fall onto face)
  2. Edema and Hemorrhage into the central cord
    1. Gray matter
    2. Spinothalamic Tract (pain and Temperature sense) may be affected
      1. Spinothalamic Tract injury is more associated with Anterior Cord Syndrome
    3. Lateral Corticospinal tracts (motor function)
      1. Upper extremities are localized to the medial or central aspect of the Corticospinal tract
      2. Upper extremities are more affected than lower extremties in Central Cord Syndrome
  3. Images
    1. CordSyndrome.jpg

IV. Precautions

  1. Have a high index of suspicion in Trauma
  2. Findings may initially be subtle and mistakenly attributed to peripheral injury

V. Causes

  1. Older patients (most common)
    1. Cervical Spondylosis
    2. Cervical SpineOsteoarthritis
  2. Athletes
    1. Hyperextension with ligamentum flavum buckling
  3. Other mechanisms
    1. Unrestrained in Motor Vehicle Accident

VI. Signs

  1. Bilateral motor weakness
    1. Upper extremities affected more than the lower extremities
    2. Distal extremities affected more than proximal extremities
  2. Sensory deficiency
    1. Variable
    2. Hyperesthesia may be present

VII. Imaging

  1. MRI Spine without contrast (preferred)
  2. CT Spine
    1. Typically performed as initial study in Trauma
    2. May demonstrate Fracture or spinal subluxation
    3. However, CT is unlikely to identify cord compression

VIII. Management

  1. See Trauma Evaluation
  2. General Measures
    1. Full Spine Immobilization
    2. Maintain mean arterial pressure 85 to 90 mmHg
      1. Preserve injured cord perfusion and prenumbra
    3. Corticosteroids are NOT recommended (since 2013 in U.S.)
      1. Despite associated inflammatory cascade and associated compression
  3. Consult Neurosurgery
  4. Decompression Surgery
    1. In acute Trauma-related cases, may result in better neurologic outcomes
    2. Anderson (2015) Neurosurgery 77(suupl 4):S15-32 [PubMed]

IX. Prognosis

  1. Better than with other Partial Cord Syndromes

X. References

  1. Broder (2022) Crit Dec Emerg Med 36(3): 25
  2. Decker in Chorley and Bachur (2014) Overview of Cervical Spinal Cord Injuries..., UpToDate, Wolters-Kluwer
  3. Rodriguez, Winger, Poulo and Glunk (2023) Crit Dec Emerg Med 37(3): 23-9
  4. Wagner (1997) Emerg Med Clin North Am 15:699-711 [PubMed]

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Related Topics in Cervical Spine Disorders

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