Management of acute traumatic central cord syndrome: a case report and literature review

<h3></h3> We report a case of a right-handed microbiologist with a history of frequent syncopal episodes and mild upper limb paraesthesia when working in a biosafety cabinet, presenting to hospital with high thoracic sensory level, predominantly distal quadriparesis (ASIA C), and facial injuries following a fall. An MRI of the spine done in the emergency department showed prominent C5-6 disk bulge causing severe spinal canal stenosis and central cord signal change at C5 level. Diagnosis of acute traumatic central cord syndrome (CCS) was made and neurosurgical opinion requested. The surgeons advised intensive physiotherapy and follow- up in 3-6 months’ time for consideration of decompression surgery if the patient‘s symptoms improved. Despite some concerns about this outcome from the neurology, medical, and therapy teams, ten days later most of the patient‘s symptoms had indeed resolved with only moderate right hand weakness persisting at the time of transfer for further rehabilitation. Views on optimal management of acute traumatic CCS have changed over the decades and remain controversial. Recent studies have shown improvement in outcomes, particularly hand function, with early surgical intervention. With the aging population, incidence of CSS is increasing. Identifying therapeutic approaches that lessen impairment in this susceptible population should be a priority.