Central Cord Syndrome

• This is an incomplete spinal cord syndrome (meaning there is some sensory and/or motor function below the level of the injury that may be only in the saddle/sacral region) so check these on physical examination
• It is a clinical diagnosis with upper extremity weakness (typically weakness in hands>arm>shoulder) greater than lower extremity weakness (findings may be subtle so a careful assessment of power is essential); in a minority of cases, there is some bowel/bladder dysfunction.
• The 3 predominant phenotypes are
  1. Elderly patients who have a low energy fall sustaining a hyperextension mechanism,
  2. High energy trauma (often MVC) that causes hyperextension in a younger patient or
  3. Patients with a fracture/dislocation of the c-spine
• CT is the test of choice in the ED and a CT-angiogram of the carotids should be considered as well; CT typically shows no fracture/dislocation and only degenerative disc disease; it is important to maintain a high index of suspicion regardless of the CT findings, even if the CT is normal; typically full spine MRI is done as an inpatient

The Podcast: EM Quick Hits 36 Surviving Sepsis, Angle Closure Glaucoma, Bougies, Frostbite, Hot/Altered Patient, Central Cord Syndrome