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Central Cord Syndrome — SCE Neurology MCQ

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ModerateCerebrovascular DiseaseCentral Cord SyndromeSCE Neurology

A 65-year-old man falls and hyperextends his cervical spine. Post-fall he has bilateral upper limb weakness (MRC 2/5) much greater than lower limb weakness (MRC 4/5). Bladder function is impaired. He has a 'cape-like' sensory loss to pain and temperature across the shoulders and upper arms. MRI shows central cord signal change at C3–C5 with pre-existing cervical spondylosis. What syndrome does he have?

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Correct answer: B — Central cord syndrome

Central cord syndrome is the most common incomplete SCI pattern, typically occurring in elderly patients with cervical spondylosis after hyperextension injury. Upper limbs are weaker than lower limbs (because the motor fibres for the upper limbs are more centrally located in the corticospinal tract). Bladder dysfunction and cape-like dissociated sensory loss occur from damage to the crossing spinothalamic fibres in the central cord. Prognosis: lower limbs recover first, then bladder, then upper limbs; hand function recovers last. A: Brown-Séquard is hemisection. C: Anterior cord syndrome spares dorsal columns. D: Posterior cord syndrome loses proprioception. E: Complete transection has no sparing.

Reference: NICE NG62 Spinal Cord Injury; Clinical Neuroanatomy