A 62-year-old man sustains a hyperextension injury to the cervical spine. He has greater weakness in the upper extremities than the lower, with sacral sensory sparing. Which incomplete SCI syndrome is most consistent?

A 62-year-old man sustains a hyperextension injury to the cervical spine. He has greater weakness in the upper extremities than the lower, with sacral sensory sparing. Which incomplete SCI syndrome is most consistent?

• A. Posterior cord syndrome
• B. Anterior cord syndrome
• C. Brown-Séquard syndrome
• D. Central cord syndrome

Answer: (D)

Central cord syndrome is characterized by disproportionately greater weakness in the upper limbs than the lower limbs after a cervical spinal injury, with sacral sparing. This pattern is classic after a hyperextension injury in an older adult (often with cervical spondylosis), where the central cervical cord is affected. The central fibers that control the arms—along with crossing fibers of the spinothalamic tract in this region—are damaged first, so arm weakness is prominent while leg function and sacral function are relatively preserved. Sensation may be variably affected, sometimes with a cape‑like distribution of pain and temperature loss around the shoulders and arms, but sacral sensation is typically spared. This combination fits central cord syndrome best.

Central cord syndrome is characterized by disproportionately greater weakness in the upper limbs than the lower limbs after a cervical spinal injury, with sacral sparing. This pattern is classic after a hyperextension injury in an older adult (often with cervical spondylosis), where the central cervical cord is affected. The central fibers that control the arms—along with crossing fibers of the spinothalamic tract in this region—are damaged first, so arm weakness is prominent while leg function and sacral function are relatively preserved. Sensation may be variably affected, sometimes with a cape‑like distribution of pain and temperature loss around the shoulders and arms, but sacral sensation is typically spared. This combination fits central cord syndrome best.