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Acute traumatic central cord syndrome

Dr Yuranga Weerakkody et al.

Acute traumatic central cord syndrome(ATCCS) (which is a type of central cord syndrome) is the most common type of incomplete spinal cord injury.

Epidemiology

It most often occurs in older persons with underlying cervical spondylosis caused by a hyperextension mechanism. It also occurs in younger persons who sustain trauma to the cervical spine. The upper extremities are more affected than the lower extremities, with motor function more severely impaired than sensory function.

Pathology

It primarily the center of the spinal cord and is frequently haemorrhagic.

Associations

hyperextension teardrop fracture : can have associated ACTTS in ~ 80% of cases ⁷

Radiographic features

Plain film - CT

May be normal or may show spondylosis or congenital canal stenosis. The presence of an extension teardrop fracture may be a warning sign.

MRI spine

T1 : affected region is usually iso signal to rest of cord
T2 : increased signal centrally within the cord at the affected level

Etymology

It was first described by R C Scheider et.al in 1954 ¹

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References

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1. Schneider RC, Cherry G, Pantek H. The syndrome of acute central cervical spinal cord injury; with special reference to the mechanisms involved in hyperextension injuries of cervical spine. J. Neurosurg. 1954;11 (6): 546-77. doi:10.3171/jns.1954.11.6.0546 - Pubmed citation
2. Quencer RM, Bunge RP, Egnor M et-al. Acute traumatic central cord syndrome: MRI-pathological correlations. Neuroradiology. 1992;34 (2): 85-94. - Pubmed citation
3. Nowak DD, Lee JK, Gelb DE et-al. Central cord syndrome. J Am Acad Orthop Surg. 2009;17 (12): 756-65. J Am Acad Orthop Surg (full text) - Pubmed citation
4. Miyanji F, Furlan JC, Aarabi B et-al. Acute cervical traumatic spinal cord injury: MR imaging findings correlated with neurologic outcome--prospective study with 100 consecutive patients. Radiology. 2007;243 (3): 820-7. doi:10.1148/radiol.2433060583 - Pubmed citation
5. Collignon F, Martin D, Lénelle J et-al. Acute traumatic central cord syndrome: magnetic resonance imaging and clinical observations. J. Neurosurg. 2002;96 (1 Suppl): 29-33. - Pubmed citation
6. Martin D, Schoenen J, Lenelle J et-al. MRI-pathological correlations in acute traumatic central cord syndrome: case report. Neuroradiology. 1992;34 (4): 262-6. - Pubmed citation
7. Rao SK, Wasyliw C, Nunez DB. Spectrum of imaging findings in hyperextension injuries of the neck. Radiographics. 25 (5): 1239-54. doi:10.1148/rg.255045162 - Pubmed citation