Review Question - QID 215590

This patient likely has central cord syndrome, which causes weakness and burning in the upper extremities preferentially.

Central cord syndrome is the most common incomplete spinal cord injury, and typically occurs in elderly individuals with pre-existing cervical spine degeneration and canal narrowing. Often, a minor trauma exacerbates the existing stenosis and causes excessive compression on the spinal cord, affecting the lateral corticospinal tract. The lateral corticospinal tract is responsible for sending efferent motor signals from the brain to the extremities. The upper extremities nerve fibers are located more centrally within the lateral corticospinal tract compared to the lower extremities, which is why upper extremities are affected more commonly. Thankfully, most patients have a good prognosis, although many never fully recover to their pre-injury level of function.

Aarabi et al review the management of acute central cord syndrome. They note that it usually causes upper extremity > lower extremity weakness and variable involvement of the sensory system/bladder. They follow this by describing both nonoperative and operative techniques for best managing this pattern of incomplete cord injury.

Yalamarthy et al reviewed 37 articles discussing both the management and prognosis of acute central cord syndrome. They recommend early surgery (<24h) in patients who have acute central cord syndrome secondary to fracture, dislocation or disc herniation, citing favorable outcomes, but recommend further investigation into those who have preexisting stenosis and a subsequent trauma. They finish by stating that the practitioner must discuss the pros and cons of surgery with the patient based on their prior level of function and neurological deterioration.

Figure A represents a sagittal MRI cut demonstrating cervical stenosis.

Incorrect Answers:
Answer 1: Decreased proprioception and positional sense would be seen in posterior cord syndrome, which is very rare and involves injury to the dorsal columns.
Answer 2: Right sided motor dysfunction and left sided numbness would be seen below the level of traumatic injury in Brown-Sequard syndrome.
Answer 4: Decreased temperature awareness is seen in anterior cord syndrome as the lateral spinothalamic tract is affected.
Answer 5: Preferential weakness in the lower extremities more commonly represents anterior cord syndrome, which is usually due to direct compression of the spinal cord or anterior spinal artery injury.