Central cord syndrome in spinal cord injury
Central cord syndrome is an incomplete traumatic spinal cord injury syndrome that most commonly involves disproportionate weakness in the arms and hands compared with the legs. [1] Central cord syndrome typically involves injury to the central portion of the cervical spinal cord and is usually associated with neck (cervical) trauma. [1]
Core clinical features
Central cord syndrome is characterized by arm-predominant motor impairment with relative sparing of leg strength. [2] Variable sensory loss can occur in a pattern associated with the cervical cord involvement. [2] Hand function impairment is often prominent early in the course. [1]
Typical mechanisms of injury
Central cord syndrome is commonly associated with traumatic events that cause cervical hyperextension (for example, a fall). [1] Cervical spinal canal narrowing from degenerative changes increases susceptibility to central cord syndrome after minor trauma. [1]
Neuroanatomic basis
The clinical pattern of central cord syndrome reflects preferential involvement of spinal cord fibers serving the upper extremities within the cervical cord. [2] Compression and injury mechanisms described for central cord syndrome include effects of hyperextension on a susceptible cervical canal. [2]
Terminology and classification
Central cord syndrome is also described as central cervical cord syndrome. [1] Central cord syndrome is considered a form of incomplete spinal cord injury, where some spinal pathways and functions below the lesion remain. [1]
Prognostic considerations
Recovery in central cord syndrome often shows a characteristic sequence in which leg function improves earlier than arm and hand function in many patients. [1] Older age and more severe initial neurologic deficit are associated with worse neurologic recovery in published reviews. [2]
Clinical implications
Central cord syndrome warrants urgent medical evaluation because cervical spinal cord injury can be associated with progressive neurologic deterioration and requires assessment for spinal instability and ongoing compression. [1] Magnetic resonance imaging and other urgent evaluation strategies are used to characterize the extent of spinal cord injury and associated structural pathology. [2]
Key distinctions from other incomplete spinal cord injury syndromes
Central cord syndrome is differentiated from other incomplete SCI syndromes by its hallmark upper-extremity greater-than-lower-extremity weakness pattern. [2]