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 Studies

Ontology: Central Cord Syndrome (C0560651)

Definition (MSH) A syndrome associated with traumatic injury to the cervical or upper thoracic regions of the spinal cord characterized by weakness in the arms with relative sparing of the legs and variable sensory loss. This condition is associated with ischemia, hemorrhage, or necrosis involving the central portions of the spinal cord. Corticospinal fibers destined for the legs are spared due to their more external location in the spinal cord. This clinical pattern may emerge during recovery from spinal shock. Deficits may be transient or permanent.
Concepts Injury or Poisoning (T037)
MSH D020210
SnomedCT 282787000
Dutch central cord syndrome, Centrale-ruggenmergsyndroom, Syndroom, centrale-ruggenmerg-
French Syndrome central moelle, Syndrome central de la moelle épinière, Syndrome central de la moelle, Syndrome centro-médullaire, Syndrome centromédullaire, Syndrome syringomyélique
German Central Cord Syndrom, Chorda zentralis-Syndrom
Italian Sindrome del canale centrale midollare, Sindrome da lesione del midollo spinale centrale, Sindrome del midollo spinale centrale
Portuguese Síndrome central da medula espinhal, Síndrome da Medula Espinhal Central, Síndrome da Medula Espinal Central, Síndrome Medular Central
Spanish Síndrome de la médula espinal, síndrome de cordón espinal central (trastorno), síndrome de cordón espinal central, Síndrome del Cordón Central
Swedish Bröstryggmärgssyndrom
Japanese ｾｷｽﾞｲﾁｭｳｼﾝｼｮｳｺｳｸﾞﾝ, 脊髄中心症候群, 中心性脊髄症候群, 中心索症候群
Czech centrální syndrom míšní, Syndrom centrální míšní šedi
Finnish Sentraalinen selkäydinoireyhtymä
Russian MOZGA SPINNOGO SHEINO-GRUDNOGO OTDELA SINDROM, МОЗГА СПИННОГО ШЕЙНО-ГРУДНОГО ОТДЕЛА СИНДРОМ
English Central Cord Injury Syndrome, Central Spinal Cord Syndrome, Central Cord Syndrome, Central Cord Syndrome [Disease/Finding], central cord syndrome, central spinal cord syndrome, central cord syndrome (diagnosis), Central cord syndrome, Central cord syndrome (disorder)
Polish Zespół części środkowej rdzenia
Hungarian Gerincvelői syndroma
Norwegian Sentromedullært syndrom
Derived from the NIH UMLS (Unified Medical Language System)

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