Makindo Medical Notes

The most common cause of Central Spinal Cord Syndrome is a hyperextension injury to the neck, often associated with falls, motor vehicle accidents, or sports injuries, particularly in older adults with pre-existing cervical spine degeneration. In older, frail patients, a bruise to the forehead and weak arms may suggest central cord syndrome.

About

• Central Spinal Cord Syndrome is most commonly caused by hyperextension injury to the neck.
• It is often associated with falls, motor vehicle accidents, or sports injuries.
• Frequently linked to existing cervical spondylosis (degenerative changes in the cervical spine).

Anatomy

• Central cord syndrome primarily affects the central portion of the spinal cord, which carries nerve fibers that control motor functions of the upper limbs more than the lower limbs.

Aetiology

• A hyperextension injury causes cord compression between the vertebral body and the ligamentum flavum.
• This results in damage to the center of the spinal cord, affecting central tracts like the spinothalamic and corticospinal tracts.
• Central cord carries more fibers for upper limbs than lower limbs, leading to greater arm weakness.
• May be due to compromise of the anterior spinal artery.
• Fractures may or may not be present with central cord syndrome.
• Autonomic dysreflexia may be seen in lesions higher than T6.

Clinical Features

• Weakness is more pronounced in the arms than the legs due to the arrangement of nerve fibers.
• There may be a "cape-like" area of sensory loss affecting the hands, arms, and chest.
• Patients often experience neck pain at the site of spinal cord impingement.
• Spasticity and upper motor neuron (UMN) signs may be present, but patients may still be able to walk.
• Bladder dysfunction, such as urinary retention or incontinence, may occur.
• Rarely, patients may experience upper limb areflexia or Horner's syndrome.
• Autonomic dysreflexia and neuropathic pain are common:
• Occurs in the first month of injury.
• Symptoms include headaches, flushing, piloerection (goosebumps), increased blood pressure, anxiety, and nausea. These symptoms are often episodic.

Investigations

• MRI: The most useful imaging modality for diagnosing Central Spinal Cord Syndrome, as it shows the extent of spinal cord compression, edema, or hemorrhage.
• CT spine: Useful if MRI is unavailable or contraindicated, but primarily shows bone abnormalities.
• Electrophysiological Tests: Nerve conduction studies or somatosensory evoked potentials (SSEPs) may assess the extent of nerve damage.

Management

• Initial Care: ABCs (Airway, Breathing, Circulation), oxygen, IV fluids, trauma management, and early neurorehabilitation. Bowel and bladder care is essential.
• Surgical Intervention: Acute surgery is not usually required unless there is significant spinal cord compression.
• Recovery: Many patients regain use of their legs and may be able to walk, but arm and hand function is often more severely affected.
• Prognosis is generally better in younger patients compared to older patients.
• Autonomic Dysreflexia: Prevention includes education for patients, caregivers, and hospital staff about the warning signs of autonomic dysreflexia. Management during an acute episode includes:
• Positioning the patient upright, removing tight clothing, and eliminating noxious stimuli such as skin pressure, urinary catheter malfunction, or bowel impaction.
• In severe cases, medications such as nitrates, hydralazine, or labetalol may be required for blood pressure control.
• Neuropathic Pain: Consider medications such as gabapentin or pregabalin, tricyclic antidepressants (TCAs), or SSRIs/SNRIs.
• Spasticity: Medications like baclofen may help manage spasticity.

References

• The National Institutes of Neurological Disorders and Stroke website — includes information on clinical trials, patient organizations, and recent research publications.
• Central Cord Syndrome — detailed clinical overview from NCBI.

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