Central Cord Syndrome

FACTS

  • mechanism: hyper-extension i/s/o DOC (anterior) and thickened ligamentum flavum (posterior)
  • affects UE > LE because of somatotopic organization of spinal cord
    • center of spinal cord = more watershed and susceptible to ischemia from anemia
      • contains more cervical fibers
    • periphery of spinal cord

HPI

universal ROS
  • blow to upper face/forehead?
  • timing of improvement (usually LEs first)
 

PHYSICAL EXAM

Universal spine exam
  • rectal exam
  • detailed sensory exam (evaluate for dysthesias as well)

IMAGING

CT C-spine: evaluate for presence of DOC, noting that CCS can occur without cervical fracture/dislocation. Younger patients more likely to have traumatic discs / fractures

MRI C-spine without to evaluate for cord edema, signal change, and concomitant signal change on STIR (ligamentous injury)
A/P
Medical management
  • Aline, MAP > 85
Surgical management is indicated if there is ongoing compression or severe dysthesia
  • progressive deterioration → emergency
  • spinal instability / long-tract findings → urgent (≤ 24hr)
  • patients who are improving: reasonable to do surgery electively

Elderly male following a fall down stairs

(Top left) CT C-spine demonstrating no acute fx but a large C3-4 DOC (top right, bottom left) MRI T2 images showing severe spinal cord compression w/ a focal area of L myelomalacia (T2 hyperintensity) below the level of DOC. (bottom right) severe spinal cord stenosis at level of DOC (C3-4) 2/2 thickened ligamentum flavum posteriorly and DOC anteriorly.
(Top left) CT C-spine demonstrating no acute fx but a large C3-4 DOC (top right, bottom left) MRI T2 images showing severe spinal cord compression w/ a focal area of L myelomalacia (T2 hyperintensity) below the level of DOC. (bottom right) severe spinal cord stenosis at level of DOC (C3-4) 2/2 thickened ligamentum flavum posteriorly and DOC anteriorly.