An Atypical Presentation of Acute Central Cord Syndrome

Abstract

Central cord syndrome (CCS) is the most common form of incomplete spinal cord injury and is classically characterized by greater impairment in the upper extremities compared to the lower extremities. However, atypical clinical presentations may create diagnostic challenges. A 65-year-old male patient presented with cervical trauma following a fall from a height of approximately 2 m. Neurological examination revealed complete motor loss (0/5) in the lower extremities, while upper extremity motor strength was assessed as 3/5 bilaterally. Cervical computed tomography demonstrated a C5 fracture and traumatic disc herniation. Magnetic resonance imaging revealed central cord edema at the C4–C6 levels. No findings of complete cord transection were observed. Based on clinical and radiological findings, the patient was diagnosed with atypical CCS. This case demonstrates that CCS may rarely present with paraplegia, while upper extremity function can be partially preserved. Awareness of such atypical presentations is important for preventing misdiagnosis and determining appropriate treatment strategies.