Post-traumatic central cord syndrome with bilateral multilevel cervical cord involvement, pure motor component

Abstract

Introduction

Spinal cord injury post-trauma remains as one of the life devastating injuries with multiple complications among the population. Central cord syndrome characterized by greater motor impairment in upper limbs compared to lower limbs, a variable degree of sensory loss below the injury level and bladder dysfunction. In the emergency setting, it is important to identify the signs and symptoms, subsequently, start the immediate treatment in order to reduce the morbidity in the patient.

Case report

A case of post-traumatic injury in a 47-year-old man with no comorbid, he presented with bilateral upper limbs motor weakness from C5-T1 with no lower limbs weakness. He had pure motor involvement with intact sensation. No cervical and spinal tenderness. No bladder dysfunction. He was suspected to have central cord syndrome. Early magnetic resonance imaging of spine aided in the diagnosis. There was multilevel cervical spondylosis with spinal canal stenosis at C3/C4, C4/C5 and C5/C6 with bilateral C6 nerve roots impingement. C4/C5 and C5/C6 spinal canal space were narrowed to 0.6 cm and 0.7 cm respectively. No spinal cord oedema or haemorrhage. He was started on steroid therapy with no surgical intervention. He had a satisfactory recovery upon discharge with quality of life.

Discussion & Conclusion

In this case, this man with no comorbid, he did not complain of any cervical and spinal tenderness post-trauma. He had disproportionate significant weakness over both upper limbs, compared to his lower limbs power. Early recognition of possible spinal cord injury and appropriate imaging modality will aid and fasten a patient’s diagnosis and treatment. A high index of suspicious was required even in a patient with no cervical and spinal tenderness. Patient management largely depends on the local setting and available expertise.