What is central cord syndrome?
What are the symptoms of central cord syndrome?
How is central cord syndrome diagnosed?
How is central cord syndrome treated?
What is the prognosis for central cord syndrome?

What is central cord syndrome?

Central cord syndrome (also known as central cervical cord syndrome) is a form of spinal cord injury characterized by impairment in the arms and to a lesser extent in the legs. The brain's ability to send and receive signals to and from parts of the body below the site of injury is reduced but not entirely blocked. This syndrome is associated with damage to the large nerve fibers that carry information directly from the brain to the spinal cord, which are particularly important for hand and arm function. Central cord syndrome is usually the result of trauma, either to the neck or the head, causing the spinal cord to hit against the bony spine, a bone spur, or a herniated disc. Although rare, it may also develop in persons over the age of 50 due to gradual weakening of the vertebrae and discs, which narrows the spinal column and may contribute to compression of the spinal cord.

What are the symptoms of central cord syndrome?

Symptoms of central cord syndrome may include paralysis or loss of fine control of movements in the arms and hands, with relatively less impairment of leg movements. Sensory loss below the site of the injury and loss of bladder control may also occur. The overall amount and type of functional loss is dependent upon the severity of nerve damage.

How is central cord syndrome diagnosed?

In addition to the history and neurologic examination, magnetic resonance imaging (MRI) is the mainstay of diagnosis for central cord syndrome, where one can see direct evidence of spinal cord injury in the neck, and sometimes the offending agent which is often fractured bone, protruded disc, or bleeding. While computed tomography (CT) scan of the neck or plain x-rays can sometimes show fractures or dislocations in the bones of the neck, they are not good studies for diagnosis of spinal cord injury. There are no specific laboratory or blood test that can confirm the diagnosis of central cord syndrome.

How is central cord syndrome treated?

The main mode of treatment for this condition is expectant management with supportive care such as physical and occupational therapies. The focus of physical therapy is preservation of range of motion and enhancement of mobility skills, whereas the goal of occupational therapy is restoration of basic activities of daily living including bowel/bladder care which may be, at least initially, impaired in patients with central cord syndrome.

The use of steroid anti-inflammatory medications for the treatment of central cord syndrome is controversial; however, there is evidence that a low blood pressure for the several days after the injury can lead to further damage to the already-injured spinal cord. Therefore, medical management is geared toward prevention of low blood pressure episodes as well as care for the patients other injuries, if there are any, since most patient with central cord syndrome are trauma victims.

Surgery is rarely indicated in the treatment of central cord syndrome, unless the patient has a fracture or other spine instability that may need to be treated surgically; or if he or she has a lesion that is compressing the spinal cord in setting of lack of clinical improvement that can be attributed to the compressive lesion.

What is the prognosis for central cord syndrome?

The prognosis for central cord syndrome varies, but most people whose syndrome is caused by trauma have some recovery of neurological function. Those who receive medical intervention soon after their injury often have good outcomes. Many people with the disorder recover substantial function after their initial injury, and the ability to walk is recovered in most cases, although some impairment may remain. Improvement occurs first in the legs, then the bladder (most patients eventually have normal spontaneous voids), and then in the arms. Hand function recovers last, if at all. Recovery is generally better in younger patients, compared to those over the age of 50.