Central cord syndrome

Central cord syndrome (CCS) is a type of spinal cord injury characterized by impairment in the arms and hands and to a lesser extent in the lower extremities. The damage is more pronounced in the upper limbs and is central because it is centrally located in the spinal cord. It is typically caused by damage to the cervical region of the spinal cord.

Etiology

Central cord syndrome is most commonly caused by hyperextension injuries to the cervical region of the spinal cord. This can occur as a result of a variety of incidents, including falls, motor vehicle accidents, and sports injuries. It is also associated with underlying conditions that cause degeneration of the cervical spine, such as arthritis and spondylosis.

Pathophysiology

The exact mechanism of injury in central cord syndrome is not fully understood. However, it is believed to involve damage to the central part of the spinal cord, which contains the nerve pathways responsible for carrying signals from the brain to the upper limbs. This damage can result in a loss of fine motor skills, such as the ability to grasp or manipulate objects, and a decrease in strength in the upper limbs.

Clinical Presentation

Patients with central cord syndrome typically present with greater weakness in the upper limbs compared to the lower limbs. This is often described as a "cape-like" distribution of sensory loss, as it affects the areas that would be covered by a cape draped over the shoulders. Other symptoms can include urinary incontinence and a variable degree of sensory loss below the level of the injury.

Diagnosis

The diagnosis of central cord syndrome is typically made based on the patient's history, physical examination, and imaging studies. Magnetic resonance imaging (MRI) is the imaging modality of choice, as it can provide detailed images of the spinal cord and surrounding structures.

Treatment

The treatment of central cord syndrome is primarily supportive and aims to manage symptoms and maximize functional independence. This can include physical therapy, occupational therapy, and pain management. In some cases, surgical intervention may be necessary to stabilize the spine or relieve pressure on the spinal cord.

Prognosis

The prognosis for central cord syndrome varies depending on the severity of the injury and the patient's overall health. However, many patients experience some degree of recovery with appropriate treatment and rehabilitation.