Board Review: Spinal Cord Syndromes
A 70-year-old woman presents after falling forward, causing her neck to bend backwards and hyperextend. She complains of burning sensation in both hands and weakness in his arms after a fall. Physical examination reveals 4/5 strength in both arms but otherwise no neurological deficits. Which of the following is the most likely diagnosis?
A. Anterior Cord Syndrome
B. Brown-Sequard Syndrome
C. Central Cord Syndrome
D. Complete Spinal Cord Syndrome
E. Cauda Equina Syndrome
Answer: C - Central Cord Syndrome
Mechanism: after fall or MVC resulting in neck hyperextension; elderly patients with DJD are more prone to bruising of ligamentum flavum with minor trauma.
Clinical: bilateral motor paresis where the upper extremities are affected more than the lower extremities; distal motor extremities affected more so than proximal; variable degree of burning paresthesias.
Anterior Cord Syndrome - complete loss of motor and pain/ temperature sensation below the lesion; from flexion or vascular injury; prognosis is poor.
Brown-Sequard Syndrome - from penetrating trauma; ipsilateral loss proprioception, motor and vibratory sensation with contralateral loss of pain and sensation.
Management: consult neurosurgery. steroids are no longer indicated for acute spinal cord injuries.