Central cord syndrome - Revision history

Danbot: Expand with concise EM-focused content: mechanism, clinical features, evaluation pearls, prognosis

2026-03-21T01:15:41Z

Expand with concise EM-focused content: mechanism, clinical features, evaluation pearls, prognosis

← Older revision		Revision as of 01:15, 21 March 2026
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	[[File:Spinal cord tracts.svg\|thumb\|Spinal cord tracts]]		[[File:Spinal cord tracts.svg\|thumb\|Spinal cord tracts]]
	[[File:Central Cord.png\|thumb\|Anatomy of central cord injury.]]		[[File:Central Cord.png\|thumb\|Anatomy of central cord injury.]]
	*Most common incomplete [[spinal cord injury]]		*Most common incomplete [[spinal cord injury]] (accounts for ~9% of all traumatic spinal cord injuries)
			*Injury to the central gray matter and medial portions of the corticospinal tracts

	===Etiology===		===Etiology===
	*~~Hyperextension injury of~~ cervical ~~spine~~		*'''Classic:''' Elderly patient with pre-existing cervical [[spondylosis]]/[[spinal stenosis]] who sustains a hyperextension injury (e.g., ground-level fall)
	*Disruption of blood flow to the spinal cord		**Ligamentum flavum buckles inward → cord contusion of central gray matter
	*Cervical [[spinal stenosis]]		**May occur '''without fracture or dislocation''' (important — can have normal plain films/CT)
	*~~Typically elderly patient with significant DJD (ligamentum~~ flavum ~~compresses~~ cord~~, causing~~ contusion to central gray ~~portion of spinal cord~~)		*Young patients: high-energy trauma with cervical fracture/dislocation
	*[[~~Syringomyelia~~]] (progressive, chronic, ~~pain/temperature loss first)~~		*Non-traumatic: [[syringomyelia]] (progressive, chronic onset), central canal ependymoma
	*Central canal ependymoma

	==Clinical Features==		==Clinical Features==
	*[[weakness~~\|Quadriparesis]]~~ (~~characteristically worse function in upper extremities than lower extremities~~)		*'''Upper extremity weakness > lower extremity weakness''' (hallmark finding)
	*~~Rare~~: ~~[[numbness\|loss of pain]]/temperature sensation in~~ upper > lower ~~extremities~~		**Due to somatotopic organization of corticospinal tract: upper extremity fibers are medial (central), lower extremity fibers are lateral (peripheral)
	*+/- bladder dysfunction/[[urinary retention]]		*'''Sacral sparing''' — distinguishes incomplete from complete injury:
	*"Sacral sparing"
	**Intact toe flexion		**Intact toe flexion
			**Intact perianal sensation
	**Normal rectal tone		**Normal rectal tone
	**Intact perianal sensation		*Variable sensory deficits: pain/temperature loss in ''cape-like'' distribution (upper extremities > lower)
	*~~Has better outcomes than other cord syndromes~~		*+/- bladder dysfunction, [[urinary retention]]

	==Differential Diagnosis==		==Differential Diagnosis==
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	==Evaluation==		==Evaluation==
	*[[~~mri\|~~MRI]] ~~for direct evidence for impingement~~		*[[MRI]] of cervical spine — gold standard; shows cord edema/contusion, pre-existing stenosis
	*CT may show ~~central canal~~ stenosis with ~~indirect estimation of impingement~~		*CT cervical spine — may show spondylosis, stenosis, fracture
			*'''Key pearl:''' May have normal CT in elderly patients with low-energy mechanism — always obtain MRI if clinical suspicion is high
			*Neurological exam: document motor levels, sensory levels, rectal tone (ASIA scoring)

	==Management==		==Management==
	{{Acute spinal cord injury treatment}}		{{Acute spinal cord injury treatment}}
			*Early surgical decompression within 24 hours is safe and effective for patients with cord compression
			*Mean arterial pressure goal ≥85 mmHg to maintain spinal cord perfusion

			==Prognosis==
			*Best prognosis of all incomplete cord syndromes (>50% regain ambulatory function)
			*Lower extremities recover first, then bladder, then upper extremities
			*Fine hand motor function recovers last and often incompletely

	==Disposition==		==Disposition==
	*~~Admission for~~ acute injury		*Admit all patients with acute spinal cord injury
	*Surgery within 24 hours is safe and effective, but may be extended to < 2 weeks after injury~~<ref>Anderson KK et al. Optimal Timing of Surgical Decompression for Acute Traumatic Central Cord Syndrome: A Systematic Review of the Literature. Neurosurgery. 2015 Oct;77 Suppl 4:S15-32.</ref>~~		*Neurosurgery consult for surgical decompression timing
			*Surgery within 24 hours is safe and effective, but may be extended to <2 weeks after injury
	~~==External Links==~~

	==See Also==		==See Also==
			*[[Spinal cord syndromes]]
			*[[Anterior cord syndrome]]
			*[[Brown-Séquard syndrome]]
	*[[Spinal cord injury]]		*[[Spinal cord injury]]
	*[[Anterior cord syndrome]]

	==References==		==References==

Dieseldoc: /* Clinical Features */

2021-10-06T01:16:35Z

Clinical Features

← Older revision		Revision as of 01:16, 6 October 2021
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	*Rare: [[numbness\|loss of pain]]/temperature sensation in upper > lower extremities		*Rare: [[numbness\|loss of pain]]/temperature sensation in upper > lower extremities
	*+/- bladder dysfunction/[[urinary retention]]		*+/- bladder dysfunction/[[urinary retention]]
			*"Sacral sparing"
			**Intact toe flexion
			**Normal rectal tone
			**Intact perianal sensation
	*Has better outcomes than other cord syndromes		*Has better outcomes than other cord syndromes

Dieseldoc: /* Etiology */

2021-10-06T01:13:09Z

Etiology

← Older revision		Revision as of 01:13, 6 October 2021
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	*Disruption of blood flow to the spinal cord		*Disruption of blood flow to the spinal cord
	*Cervical [[spinal stenosis]]		*Cervical [[spinal stenosis]]
	*Typically elderly patient with significant DJD (ligamentum flavum compresses cord, causing contusion to central portion of spinal cord)		*Typically elderly patient with significant DJD (ligamentum flavum compresses cord, causing contusion to central gray portion of spinal cord)
	*[[Syringomyelia]] (progressive, chronic, pain/temperature loss first)		*[[Syringomyelia]] (progressive, chronic, pain/temperature loss first)
	*Central canal ependymoma		*Central canal ependymoma

Elcatracho: /* Clinical Features */

2021-02-01T21:42:24Z

Clinical Features

← Older revision		Revision as of 21:42, 1 February 2021
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	==Clinical Features==		==Clinical Features==
	*[[weakness\|Quadriparesis]] (characteristically worse function in upper extremities than ~~lowers~~)		*[[weakness\|Quadriparesis]] (characteristically worse function in upper extremities than lower extremities)
	*Rare: [[numbness\|loss of pain]]/temperature sensation in upper > lower extremities		*Rare: [[numbness\|loss of pain]]/temperature sensation in upper > lower extremities
	*+/- bladder dysfunction/[[urinary retention]]		*+/- bladder dysfunction/[[urinary retention]]

Rossdonaldson1: /* Background */

2020-10-24T11:21:49Z

Background

← Older revision		Revision as of 11:21, 24 October 2020
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	[[File:Dermatoms alt.png\|thumb\|Sensory dermatome by spinal level.]]		[[File:Dermatoms alt.png\|thumb\|Sensory dermatome by spinal level.]]
	[[File:Spinal cord tracts.svg\|thumb\|Spinal cord tracts]]		[[File:Spinal cord tracts.svg\|thumb\|Spinal cord tracts]]
			[[File:Central Cord.png\|thumb\|Anatomy of central cord injury.]]
	*Most common incomplete [[spinal cord injury]]		*Most common incomplete [[spinal cord injury]]

Rossdonaldson1: /* Background */

2020-10-24T11:11:14Z

Background

← Older revision		Revision as of 11:11, 24 October 2020
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	==Background==		==Background==
			[[File:Dermatoms alt.png\|thumb\|Sensory dermatome by spinal level.]]
	[[File:Spinal cord tracts.svg\|thumb\|Spinal cord tracts]]		[[File:Spinal cord tracts.svg\|thumb\|Spinal cord tracts]]
	*Most common incomplete [[spinal cord injury]]		*Most common incomplete [[spinal cord injury]]

Alexgrohmann: /* Clinical Features */

2020-03-02T03:13:10Z

Clinical Features

← Older revision		Revision as of 03:13, 2 March 2020
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	*Rare: [[numbness\|loss of pain]]/temperature sensation in upper > lower extremities		*Rare: [[numbness\|loss of pain]]/temperature sensation in upper > lower extremities
	*+/- bladder dysfunction/[[urinary retention]]		*+/- bladder dysfunction/[[urinary retention]]
			*Has better outcomes than other cord syndromes

	==Differential Diagnosis==		==Differential Diagnosis==

ClaireLewis at 00:11, 3 October 2019

2019-10-03T00:11:16Z

← Older revision		Revision as of 00:11, 3 October 2019
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	==Clinical Features==		==Clinical Features==
	*Quadriparesis (characteristically worse function in upper extremities than lowers)		*[[weakness\|Quadriparesis]] (characteristically worse function in upper extremities than lowers)
	*Rare: loss of pain/temperature sensation in upper > lower ~~extremities~~		*Rare: [[numbness\|loss of pain]]/temperature sensation in upper > lower extremities
	*Rare loss of pain and temperature sensation, also greater in upper extremities		*+/- bladder dysfunction/[[urinary retention]]
	*+/- bladder dysfunction/urinary retention

	==Differential Diagnosis==		==Differential Diagnosis==
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	==Evaluation==		==Evaluation==
	*MRI for direct evidence for impingement		*[[mri\|MRI]] for direct evidence for impingement
	*CT may show central canal stenosis with indirect estimation of impingement		*CT may show central canal stenosis with indirect estimation of impingement

ClaireLewis at 20:38, 27 January 2019

2019-01-27T20:38:06Z

← Older revision		Revision as of 20:38, 27 January 2019
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	==Background==		==Background==
	[[File:Spinal cord tracts.svg\|thumb\|Spinal cord tracts]]		[[File:Spinal cord tracts.svg\|thumb\|Spinal cord tracts]]
	*Most common incomplete spinal cord injury		*Most common incomplete [[spinal cord injury]]

	===Etiology===		===Etiology===
	*Hyperextension injury of cervical spine		*Hyperextension injury of cervical spine
	*Disruption of blood flow to the spinal cord		*Disruption of blood flow to the spinal cord
	*Cervical spinal stenosis		*Cervical [[spinal stenosis]]
	*Typically elderly patient with significant DJD (ligamentum flavum compresses cord, causing contusion to central portion of spinal cord)		*Typically elderly patient with significant DJD (ligamentum flavum compresses cord, causing contusion to central portion of spinal cord)
	*Syringomyelia (progressive, chronic, pain/temperature loss first)		*[[Syringomyelia]] (progressive, chronic, pain/temperature loss first)
	*Central canal ependymoma		*Central canal ependymoma

	==Clinical Features==		==Clinical Features==
	*Quadriparesis (characteristically ~~with~~ worse function in ~~the UL~~ than in ~~the LL)~~		*Quadriparesis (characteristically worse function in upper extremities than lowers)
			*Rare: loss of pain/temperature sensation in upper > lower extremities
	*Rare loss of pain and temperature sensation, also greater in upper extremities		*Rare loss of pain and temperature sensation, also greater in upper extremities
	*~~in contrast to anterior cord syndrome~~ - an incomplete spinal cord injury affecting the blood supply to the anterior spinal structures. Symptoms include bilateral loss of pain and temperature (via spinothalamic tracts), bilateral weakness or paralysis below the lesion (via corticospinal tracts) and loss of sphincter control.		*+/- bladder dysfunction/urinary retention

	==Differential Diagnosis==		==Differential Diagnosis==

PoppyCat: /* Clinical Features */

2019-01-21T02:07:58Z

Clinical Features

← Older revision		Revision as of 02:07, 21 January 2019
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	==Clinical Features==		==Clinical Features==
	*Quadriparesis (characteristically with worse function in the UL than in the LL)		*Quadriparesis (characteristically with worse function in the UL than in the LL)
	*~~Possible~~ loss of pain and temperature sensation, also greater in upper extremities		*Rare loss of pain and temperature sensation, also greater in upper extremities
			*in contrast to anterior cord syndrome - an incomplete spinal cord injury affecting the blood supply to the anterior spinal structures. Symptoms include bilateral loss of pain and temperature (via spinothalamic tracts), bilateral weakness or paralysis below the lesion (via corticospinal tracts) and loss of sphincter control.

	==Differential Diagnosis==		==Differential Diagnosis==