| Central Cord Syndrome |
| Classification and external resources |
Central cord syndrome is top diagram |
| ICD-9 |
T1-6 952.13
T7-12 952.18
C1-4 952.03
C5-7 952.08
Lumbar 952.2
Sacral 952.3 |
| DiseasesDB |
33409 |
| eMedicine |
pmr/22 |
| MeSH |
D020210 |
Central cord syndrome (CCS) is an acute cervical spinal cord injury (SCI) that can affect a large and diverse group of patients. It was first described by Schneider in 1954.[1]
It has been reported that CCS most frequently occurs among older persons with cervical spondylosis, however, it also may occur in younger individuals.[2]
CCS is the most common incomplete SCI syndrome. It accounts for approximately 9% of traumatic SCIs.[3] It is generally associated with favorable prognosis for some degree of neurological and functional recovery. However, factors such as age, preexisting conditions and extent of injury will affect the recovery process.
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Contents
- 1 Presentation
- 2 Causes
- 3 Nonsurgical Management
- 4 Surgical Management
- 5 See also
- 6 References
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Presentation
It is characterized by disproportionately greater motor impairment in upper compared to lower extremities, and variable degree of sensory loss below the level of injury in combination with bladder dysfunction and urinary retention.[4] This syndrome differs from that of a complete lesion, which is characterized by total loss of all sensation and movement below the level of the injury.
Causes
In older patients, CCS most often occurs after a hyperextension injury in an individual with long-standing cervical spondylosis. However, this condition is not exclusive to older patients as younger individuals can also sustain an injury leading to CCS. Typically, younger patients are more likely to get CCS as a result of a high-force trauma or a bony instability in the cervical spine.[4][5] Historically, spinal cord damage was believed to originate from concussion or contusion of the cord with stasis of axoplasmic flow, causing edematous injury rather than destructive hematomyelia. More recently, autopsy studies have demonstrated that CCS may be caused by bleeding into the central part of the cord, portending less favorable prognosis. Studies also have shown from postmortem evaluation that CCS probably is associated with selective axonal disruption in the lateral columns at the level of the injury to the spinal cord with relative preservation of the grey matter.[4]
Nonsurgical Management
In many cases, individuals with CCS can experience a reduction in their neurological symptoms with conservative management. The first steps of these intervention strategies include admission to an intensive care unit (ICU) after initial injury. After entering the ICU, early immobilization of the cervical spine with a neck collar would be placed on the patient to limit the potential of further injury.[5] Cervical spine restriction is maintained for approximately six weeks until the individual experiences a reduction in pain and neurological symptoms.[5] Inpatient rehabilitation is initiated in the hospital setting, followed by outpatient physical therapy and occupational therapy to assist with muscle retraining.
An individual with a spinal cord injury may have many goals for outpatient physiotherapy. Their level of independence, self-care, and mobility are dependent on their degree of neurological impairment. Rehabilitation organization and outcomes are also based on these impairments[6] . The physiatrist, along with the rehabilitation team, work with the patient to develop specific, measurable, action-oriented, realistic, and time-centered goals.
With respect to physical therapy interventions, it has been determined that repetitive task-specific sensory input can improve motor output in patients with central cord syndrome. These activities enable the spinal cord to incorporate both supraspinal and afferent sensory information to help recover motor output[7]. This occurrence is known as "activity dependent plasticity". Activity dependant plasticity is stimulated through such activities as: locomotor training, muscle strengthening, voluntary cycling, and functional electrical stimulation (FES) cycling[8]
Surgical Management
Surgical intervention is usually given to those individuals who have increased instability of their cervical spine, which cannot be resolved by conservative management alone. Further indications for surgery include a neurological decline in spinal cord function in stable patients as well as those who require cervical spinal decompression.[9]
See also
- Rick Hansen Foundation
- NINDS Spinal Cord Injury Information Page
- Spinal cord injury
- Anterior cord syndrome
- Posterior cord syndrome
- Brown-Sequard syndrome
References
- ^ Schneider RC, Cherry G, Pantek H (1954). "The syndrome of acute central cervical spinal cord injury; with special reference to the mechanisms involved in hyperextension injuries of cervical spine". J. Neurosurg. 11 (6): 546–77. DOI:10.3171/jns.1954.11.6.0546. PMID 13222164.
- ^ Rich V, McCaslin E (2006). "Central Cord Syndrome in a High School Wrestler: A Case Report". J Athl Train 41 (3): 341–4. PMC 1569555. PMID 17043705. http://www.pubmedcentral.nih.gov.library.mmc.org/articlerender.fcgi?tool=pubmed&pubmedid=17684887.
- ^ McKinley W, Santos K, Meade M, Brooke K (2007). "Incidence and Outcomes of Spinal Cord Injury Clinical Syndromes". J Spinal Cord Med 30 (3): 215–24. PMC 2031952. PMID 17684887. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2031952.
- ^ a b c Harrop, James S; Ashwini Sharan, Jonathon Ratliff (2006). "Central cord injury: pathophysiology, management, and outcomes". The Spine Journal 6 (6 Suppl. 1): 198S–206S. DOI:10.1016/j.spinee.2006.04.006. PMID 17097539. http://www.thespinejournalonline.com/article/S1529-9430%2806%2900194-X/abstract. Retrieved 2011-05-02.
- ^ a b c Nowak, Douglas D.; Joseph K. Lee, Daniel E. Gelb, Kornelis A. Poelstra, Steven C. Ludwig (2009-12). "Central Cord Syndrome". Journal of the American Academy of Orthopaedic Surgeons 17 (12): 756–765. PMID 19948700. http://jaaos.org/cgi/content/abstract/17/12/756. Retrieved 2011-05-02.
- ^ Behrman, Andrea, L.; Harkema, Susan J. (2007). "Physical Rehabilitation as an Agent for Recovery After Spinal Cord Injury". Physical Medicine and Rehabilitation Clinics of North America 18 (2): 183-202. DOI:10.1016/j.pmr.2007.02.002. PMID 17543768.
- ^ Behram, A.L.; Harkema, S.J. (2007). "Physical Rehabilitation as an Agent for Recovery After Spinal Cord Injury". Physical Medicine and Rehabilitation Clinics od North America 18 (2): 183-202. DOI:10.1016/j.pmr.2007.02.002. PMID 17543768.
- ^ Yadla, S.; Klimo, J.; Harrop, J.S. (2010). "Traumatic Central Cord Syndrome: Etiology, Management, and Outcomes". Topics in Spinal Cord Injury Rehabilitation 15 (3): 73-84. DOI:10.1016/j.spinee.2006.04.006. PMID 17097539.
- ^ Yadla, Sanjay; Paul Klimo, James S. Harrop (2010). "Traumatic Central Cord Syndrome: Etiology, Management, and Outcomes". Topics in Spinal Cord Injury Rehabilitation 15 (3): 73–84. DOI:10.1310/sci1503-73. http://thomasland.metapress.com/content/n0g3x3556m757701/. Retrieved 2011-05-02.
- http://health.enotes.com/neurological-disorders-encyclopedia/central-cord-syndrome
- http://www.ninds.nih.gov/disorders/central_cord/central_cord.htm
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Lesions of spinal cord and brain
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Spinal cord/
vascular myelopathy |
sensory: Sensory ataxia · Tabes dorsalis
motor: Motor neurone disease
mixed: Brown-Séquard syndrome · cord syndrome (Posterior, Anterior, Central/Syringomyelia) · Subacute combined degeneration of spinal cord (B12) · Cauda equina syndrome
Anterior spinal artery syndrome
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| Brainstem |
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Medulla (CN 8, 9, 10, 12)
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Lateral medullary syndrome/Wallenberg (PICA) · Medial medullary syndrome/Dejerine (ASA)
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Pons (CN 5, 6, 7, 8)
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Lateral pontine syndrome (AICA) (lateral) · Medial pontine syndrome/Millard-Gubler syndrome (basilar)/Foville's syndrome (dorsal, basilar) · Locked-in syndrome (ventral) · Internuclear ophthalmoplegia · One and a half syndrome
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Midbrain (CN 3, 4)
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Weber's syndrome (ventral peduncle, PCA) · Benedikt syndrome (ventral tegmentum, PCA) · Parinaud's syndrome (dorsal, tumor) · Nothnagel's syndrome · Claude's syndrome
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Other
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Alternating hemiplegia
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| Cerebellum |
lateral (Dysmetria, Dysdiadochokinesia, Intention tremor) · medial (Cerebellar ataxia)
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| Basal ganglia |
Chorea · Dystonia · Parkinson's disease
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| Cortex |
ACA syndrome · MCA syndrome · PCA syndrome
frontal lobe: Expressive aphasia · Abulia
parietal lobe: Receptive aphasia · Hemispatial neglect · Gerstmann syndrome · Astereognosis
occipital lobe: Balint's syndrome · Cortical blindness · Pure alexia
temporal lobe: Cortical deafness · Prosopagnosia
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| Other |
Subclavian steal syndrome · Upper motor neurone lesion (Clasp-knife response) · Lower motor neurone lesion
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anat(n/s/m/p/4/e/b/d/c/a/f/l/g)/phys/devp
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noco(m/d/e/h/v/s)/cong/tumr, sysi/epon, injr
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proc, drug(N1A/2AB/C/3/4/7A/B/C/D)
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