NeurologyTier 2Disease (DEADMAN)

Central cord syndrome and syringomyelia

Description

The shared anatomy

Central cord lesion damages, in order:
- Decussating spinothalamic fibres in the anterior white commissure -> suspended, dissociated loss of pain and temperature
- Anterior horn cells -> LMN weakness, wasting, areflexia at the level
- Later, the lateral corticospinal tracts (medial = arm, lateral = leg) -> UMN signs below
- Dorsal columns spared until late -> vibration and proprioception preserved

Syringomyelia

Fluid-filled cavity within the cord, usually cervical, expanding over years
Classic triad
- Cape-distribution loss of pain and temperature over neck, shoulders and arms
- Amyotrophy of the arms - weakness, wasting, areflexia
- UMN signs in the legs
Also: painless burns and cuts, trophic skin changes from unnoticed injury, Charcot joints (shoulder/elbow), thoracic scoliosis from asymmetric paraspinal weakness
Syringobulbia if it extends into the medulla - tongue wasting, palatal weakness, nystagmus, Horner, facial pain/temperature loss in an onion-skin pattern

Central cord syndrome

Commonest incomplete spinal cord syndrome
Arms >> legs weakness, distal arm worst ("man in a barrel")
Variable sensory loss below the level; sacral sparing
Bladder dysfunction, usually retention
Classically hyperextension injury in an older person with pre-existing cervical spondylosis, often without fracture

Distinguishing the cord syndromes

	Motor	Pain/temp	Dorsal columns
Central cord	Arms > legs	Suspended/dissociated	Spared
Anterior cord	Complete below level	Lost below level	Spared
Brown-Sequard	Ipsilateral below	Contralateral below	Ipsilateral lost
Posterior cord	Preserved	Preserved	Lost (sensory ataxia)
Conus medullaris	Symmetric, mild	Saddle, symmetric
Cauda equina	Asymmetric, LMN	Saddle, asymmetric, radicular pain

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