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Central cord syndrome

Definition
CCS is an incomplete traumatic spinal cord injury characterized by preferential upper extremity motor impairment and bladder dysfunction.
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Pathophysiology
In younger patients (< 40-50 years of age), CCS is associated with high-speed motor vehicle collisions, falls, athletic injuries, diving, assault, or gun-shot wounds, whereas low energy trauma (including falls from standing height) is the main mechanism in older patients (> 45-50 years of age).
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Disease course
Clinical manifestations include disproportionately greater upper extremity weakness compared with lower extremity weakness, bladder dysfunction, urinary retention, and varying degree of sensory loss below the level of the lesion. Neurogenic shock (bradycardia, hypotension) may also be present.
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Prognosis and risk of recurrence
The overall in-hospital mortality rate for CCS is estimated at 2.6%.
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Key sources
The following summarized guidelines for the evaluation and management of central cord syndrome are prepared by our editorial team based on guidelines from the Congress of Neurological Surgeons (CNS/AOSpine 2017) and the American Association of Neurological Surgeons (AANS/CNS 2013).
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Guidelines

1.Diagnostic investigations

Cardiorespiratory monitoring: maintain mean arterial BP at 85 to 90 mmHg during the first week after spinal cord injury to improve spinal cord perfusion, and implement close medical, cardiac, hemodynamic, and respiratory monitoring.
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2.Medical management

Setting of care: admit patients with acute traumatic CCS to an ICU, particularly patients with severe neurological deficits.
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3.Surgical interventions

Surgical decompression: perform surgical decompression of the compressed spinal cord, particularly if the compression is focal and anterior.
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