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Central Cord Syndrome

advanced
6 min
28 marks
6 questions
Clinical Scenario
A 72-year-old man presents after falling forward onto his forehead. He has disproportionate weakness in his arms compared to his legs. He can wiggle his toes but cannot grip or extend his fingers. He has a band of numbness across both arms and reports burning pain in his hands. He has a history of neck stiffness for years. Examination shows 2/5 power in upper limbs, 4/5 in lower limbs, and intact bladder function.
Sagittal T2-weighted MRI demonstrating multilevel cervical spondylosis with stenosis from C3-6. There is central cord T2 hyperintensity at C4-5 level indicating cord edema/contusion. There is no fracture or dislocation. This represents central cord syndrome from hyperextension injury in a patient with pre-existing cervical stenosis.
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Sagittal T2-weighted MRI demonstrating multilevel cervical spondylosis with stenosis from C3-6. There is central cord T2 hyperintensity at C4-5 level indicating cord edema/contusion. There is no fracture or dislocation. This represents central cord syndrome from hyperextension injury in a patient with pre-existing cervical stenosis.

Image source: Open Access medical literature (NIH/PubMed Central) • CC-BY License

Questions

Question 1 (4 marks)

Describe the MRI findings and explain the pathophysiology.

Question 2 (5 marks)

What are the clinical features and how does this differ from other incomplete SCI syndromes?

Question 3 (6 marks)

How do you investigate and what is the initial management?

Question 4 (5 marks)

What is the evidence regarding surgical timing?

Question 5 (4 marks)

What are the expected outcomes and recovery pattern?

Question 6 (4 marks)

Describe your surgical approach if surgery is indicated.

Exam Day Cheat Sheet

Must Mention

  • •Upper limbs weaker than lower limbs
  • •Hyperextension in spondylotic/elderly spine
  • •No fracture typically (soft tissue mechanism)
  • •Recovery: legs → bladder → proximal arms → hands
  • •Surgical timing debated (trend toward early)
  • •Approach based on pathology location

Common Pitfalls

  • •Confusing syndromes
  • •Wrong recovery order
  • •Emergency surgery for all
  • •Missing stenosis
  • •Wrong surgical approach
  • •Laminoplasty in kyphosis