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HWN Suggests

Early vs Late Surgical Decompression for Central Cord Syndrome

Treatment paradigms for CCS should be redefined to encompass early surgical decompression as a neuroprotective therapy. Surgical intervention in the setting of CCS has traditionally been discouraged, owing to fear of causing further iatrogenic injury to the spinal cord and historical reports of an otherwise favorable natural history. Nonetheless, many of the original fundamental concepts underpinning CCS have recently been challenged, and there is consequently a strong impetus to revisit treatment paradigms for this condition.

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 Central Cord Syndrome

CCS is a cervical spinal cord injury that causes motor weakness more prominent in the upper extremities than lower, a mixed sensory impairment below the level of the lesion, and bladder dysfunction. Because of its mixed distribution of sensory impairment, CCS can be described as being a “man in a barrel” or having “cape-like” sensory loss.

Articles of Interest

A Boring guide to Spinal Cord Syndromes

The classic mechanism is the elderly patient who falls, and hits their chin – causing an extension injury of the neck. Distal upper extremity motor function is most medial in the spinal cord, these are the areas that are typically most effected with patchy sensory loss. Central cord syndrome can often be missed in the ED, as the imaging in these patients is often unremarkable, and their sensory deficits can be patchy. Because it is a clinical diagnosis, it is important for the emergency physician to consider this entity during their assessment, particularly in trauma patients, where this may be overlooked.

Acute Traumatic Myelopathy: Rethinking Central Cord Syndrome

Central cord syndrome (CCS) is an incomplete spinal cord injury that consists of both sensory and motor changes of the upper and lower extremities. CCS most commonly occurs after trauma to the cervical spine leading to acute neurological changes. Despite being the most common incomplete spinal cord injury with the best outcomes, optimal treatment remains controversial.

Central cord syndrome definitions, variations and limitations

Central cord syndrome (CCS) is the most common, yet most controversial, among the different spinal cord injury (SCI) incomplete syndromes. Since its original description in 1954, many variations have been described while maintaining the core characteristic of disproportionate weakness in the upper extremities compared to the lower extremities.

Central Cord Syndrome Is Likewise a Surgical Emergency—Time Is Spine

One of the most common forms of spinal cord injury (SCI) now in the US is spinal cord contusion secondary to a fall in a patient with underlying cervical spondylosis. This central cord syndrome has produced a vexing modern conundrum: the dogma that central cord syndrome carries a more favorable prognosis leads to a higher likelihood to delay surgical decompression in clinical practice.

EM Quick Hits 36... Central Cord Syndrome

Hyperextension injury of the c-spine with upper extremity weakness and a benign CT c-spine that is easy to miss. It is a clinical diagnosis with upper extremity weakness (typically weakness in hands>arm>shoulder) greater than lower extremity weakness (findings may be subtle so a careful assessment of power is essential); in a minority of cases, there is some bowel/bladder dysfunction.

EM Reflections October 2020 – Spinal Cord Injury

Central cord syndrome involves both motor and sensory pathways and has a variable presentation. Typically one sees motor weakness in the hands and forearms with sensory preservation. Bladder dysfunction and sexual dysfunction can be seen in severe cases5. A helpful mnemonic is MUD-E6. Motor loss > sensory loss, UE > LE, Distal > proximal, Extension type injury.

How to spot central cord syndrome in abnormal neurology in the ED

Loss of function, whether it’s in the hands, arms, legs, or bladder, will depend on the severity of the injury which triggered the central cord syndrome. Generally speaking, though, patients with central cord syndrome will present with a greater loss of function in the upper extremities than in the lower extremities.

Management of Acute Traumatic Central Cord Syndrome: A Narrative Review

ATCCS is the most commonly encountered subtype of incomplete spinal cord injury and is characterized by worse sensory and motor function in the upper extremities compared with the lower extremities. It is most commonly seen in the setting of trauma such as motor vehicles or falls in elderly patients. The operative management of this injury has been historically variable as it can be seen in the setting of mechanical instability or preexisting cervical stenosis alone.

Subacute Presentation of Central Cord Syndrome Resulting from Vertebral Osteomyelitis and Discitis: A Case Report

In patients presenting with non-traumatic central cord syndrome, it is vital to identify risk factors for infection in a thoroughly obtained patient history, as well as to maintain a low threshold for diagnostic imaging.

What is Central Cord Syndrome?

Central Cord Syndrome usually occurs in elderly people that already have underlying spinal canal narrowing due to arthritic changes in their neck (called "spinal stenosis"). Often times a small injury can make a narrow space even narrower (its like the straw that breaks the camels back). An acute injury to a chronic problem will cause a sudden and major spinal cord injury.

Resources

EMnote.org

The clinical presentation of central cord syndrome may vary from patient to patient. Some common symptoms include: Bilateral motor weakness: Typically, the upper extremities are more affected than the lower extremities and the distal muscles are more affected than the proximal. Patients may experience difficulty with fine motor tasks, such as buttoning a shirt or holding objects. Sensory changes: Patients may have decreased sensation or altered perception in their arms and hands. This can range from mild numbness to more profound sensory deficits.

Physiopedia

Central cord syndrome (CCS) is the most commonly encountered incomplete spinal cord injury (SCI) type. CCS was first described in 1954 by Schneider et al. as SCI with “disproportionately more motor impairment of the upper than of the lower extremities, bladder dysfunction, usually urinary retention, and varying degrees of sensory loss below the level of the lesion.

Radiopaedia

Most often central cord syndrome occurs in the setting of trauma, and most often in older individuals with underlying cervical spondylosis. However, it may also be seen in younger persons who sustain substantial trauma to the cervical spine, for example during forceful football tackling when a player "spears" another with their head.

StatPearls

Central cord syndrome is a clinical diagnosis with a presentation that includes disproportionate impairment of the upper limb motor function compared to the lower limbs, along with varying degrees of sensory deficits below the level of the spinal cord lesion and possibly urinary or gastrointestinal dysfunction.