What type of spinal cord syndrome is suspected in a patient with greater weakness in the upper extremities compared to the lower extremities after a traumatic injury, such as a fall?

Central Cord Syndrome

The AGACNP should suspect Central Cord Syndrome (answer D), as this patient presents with the classic pattern of disproportionately greater motor weakness in the upper extremities compared to the lower extremities following a fall. 1, 2

Diagnostic Criteria

Central Cord Syndrome (CCS) is characterized by:

• Disproportionately greater motor impairment in the upper extremities compared to the lower extremities - this is the hallmark feature that distinguishes CCS from other spinal cord syndromes 1, 2
• Bladder dysfunction, typically urinary retention 1, 2
• Varying degrees of sensory loss below the level of injury 1, 2
• Preserved or relatively intact lower extremity motor function 2

Mechanism and Pathophysiology

CCS typically occurs from a hyperextension mechanism in patients with underlying cervical canal stenosis, which is particularly common in older individuals with degenerative changes 1, 2. The injury mechanism involves:

• Compression of the spinal cord between the hypertrophic spondylotic disc-osteophyte complex anteriorly and the buckled ligamentum flavum posteriorly 1, 2
• Predominant injury to the central portion of the spinal cord 1, 2
• Disruption of medially located upper extremity motor fibers in the corticospinal tracts, while laterally positioned lower extremity fibers are relatively spared 2

CCS is now the most common form of incomplete spinal cord injury and is expected to become even more prevalent with the aging population 1, 3

Why Other Options Are Incorrect

Anterior cord syndrome (Option A) presents with loss of motor function and pain/temperature sensation below the level of injury, but preservation of proprioception and vibration sense - this does not match the pattern of upper extremity predominant weakness [@general medical knowledge]

Posterior cord syndrome (Option B) is extremely rare and presents with loss of proprioception and vibration sense while preserving motor function and pain/temperature sensation - the opposite of what this patient demonstrates [@general medical knowledge]

Brown-Séquard syndrome (Option C) presents with ipsilateral motor weakness and loss of proprioception with contralateral loss of pain and temperature sensation - a hemisection pattern that does not match this patient's bilateral upper extremity predominant weakness [@general medical knowledge]

Immediate Management Priorities

Once CCS is suspected, the AGACNP should:

• Maintain spinal immobilization with manual stabilization of the head to minimize motion [@10@]
• Optimize hemodynamic parameters immediately, as cervical injuries can produce profound hypotension from loss of cardiovascular sympathetic innervation [@2@, 2]
• Arrange urgent MRI, which is the gold standard for diagnosing spinal cord contusions and compression [@10@]
• Transfer to a specialized acute spinal cord injury center within the critical therapeutic time window (ideally within 24 hours) [@2@, 2]
• Consider early surgical decompression within 24 hours, as this is strongly recommended for incomplete spinal cord syndromes including CCS to improve neurological outcomes [@10@]

Important Clinical Caveat

Recent evidence suggests that the traditional definition of CCS may be overly broad, encompassing multiple clinical presentations under a single umbrella term [@15@, 4]. However, the classic presentation described in this case - greater upper than lower extremity weakness following trauma - remains the defining feature that clinicians use to identify this syndrome [1, @10@, @14