USMLE Prep - Medical Reference Library

Central Cord Syndrome — Airway, Immobilization, and Timing of Decompression

System: Neurology • Reviewed: Aug 31, 2025 • Step 1Step 2Step 3

Synopsis:

Hyperextension injury with hand weakness greater than legs and variable sensory loss; stabilize the spine, optimize hemodynamics, and involve spine surgery to consider early decompression when deficits persist or instability exists.

Key Points

  • Stabilize ABCs; treat life‑threatening derangements immediately.
  • Confirm diagnosis early with highest‑yield imaging/labs.
  • Initiate guideline‑based therapy and escalate by response.
  • Plan disposition and follow‑up explicitly.

Clinical Synopsis & Reasoning

Central cord syndrome follows hyperextension in a stenotic cervical spine and causes disproportionate upper‑extremity weakness. Priorities are airway protection, rigid immobilization, maintenance of MAP 85–90 mmHg, and early spine surgery input. Early decompression is reasonable in persistent deficits or instability; high‑dose steroids are not routine and remain controversial.

Treatment Strategy & Disposition

Central cord syndrome follows hyperextension in a stenotic cervical spine and causes disproportionate upper‑extremity weakness. Priorities are airway protection, rigid immobilization, maintenance of MAP 85–90 mmHg, and early spine surgery input. Early decompression is reasonable in persistent deficits or instability; high‑dose steroids are not routine and remain controversial.

Epidemiology / Risk Factors

  • Risk varies by comorbidity and precipitating factors

Initial Targets

ParameterTarget/Action
HemodynamicsMaintain perfusion; avoid hypotension
MonitoringSerial exam, labs, and imaging
TherapyStart early, reassess, de‑escalate when appropriate

Investigations

TestRole / RationaleTypical FindingsNotes
CBCScreen leukocytosis/anemiaContext‑specificTrend response
BMPElectrolytes/renal functionDerangements commonReplace K+/Mg2+
Key imagingCondition‑specific (CTA/MRI/Endoscopy)See textDo not delay when red flags

Pharmacology

MedicationMechanismOnsetRole in TherapyLimitations
Norepinephrine (as needed)VasopressorMinutesMaintain MAP 85–90 mmHgArrhythmias/ischemia
Analgesia/sedation (titrated)VariousImmediateFacilitate immobilization/ventilationAvoid hypotension

Prognosis / Complications

  • Outcome depends on timeliness of diagnosis and definitive therapy

Patient Education / Counseling

  • Explain red flags, adherence, and follow‑up plan

References

  1. CNS/AANS Central Cord Syndrome Guideline — Link
  2. Guideline PDF (2017) — Link