A frail patient with a bruise to the forehead and weak arms may be suspected of having a central cord syndrome
- Hyperextension injury in the older patient that squeezes the cervical cord
- Often associated with existing cervical spondylosis
- Typically a hyperextension injury causes cord compression between vertebral body and ligamentum flavum
- Results in damage to the centre of the cord and central tracts e.g. spinothalamic and corticospinal
- May be due to compromise to the anterior spinal artery
- May be an associated fracture but not always
- Autonomic dysreflexia may be seen in lesions higher than T6
- Weakness Arms > legs as arm fibres more central
- Variable sensory deficits below the level of injury classically in a "cape-like" distribution across their upper back and down their posterior upper extremities.
- They will often have neck pain at the site of spinal cord impingement.
- Spasticity and UMN signs but may be able to walk
- Bladder dysfunction
- Rarely Upper limb areflexia and Horner's syndrome
- Autonomic dysreflexia, neuropathic pain
- Usually occurs in the first month of the injury
- Headaches, flushing, piloerection, increased BP
- Anxiety, and nausea. Usually episodic
- ABC and Oxygenate. IV fluids. Manage any trauma. Neurorehabilitation. Bowel and Bladder care.
- Acute surgical intervention is not usually necessary unless there is significant spinal cord compression
- Many regain use of their legs and can often walk, but cannot effectively use their arms and hands.
- Many have a spontaneous recovery of motor function, but others may have lasting disability after injury.
- Prognosis for CCS in younger patients is better than in older patients.
- Autonomic dysreflexia: prevention by educating patients, caregivers, and hospital staff about the potential for autonomic dysreflexia as well as warning signs. During an acute episode, management should begin by placing the patient upright, removing all tight clothes, and removing any noxious stimuli such as skin pressure, urinary catheter dysfunction, and bowel impaction.
BP monitoring may be required in selective cases for the long term, even if the patient is not diagnosed as hypertensive. Control may need nitrates, hydralazine, and labetalol.
- Neuropathic pain at the level of the injury and below the level of injury. Consider gabapentin or Pregabalin) and tricyclic antidepressants (TCA), SSRIs/SNRI
- Spasticity: Consider a trial of Baclofen and other agents.