A 55-year-old woman with a hyperextended neck injury presents with spastic paraplegia, loss of pain sensation in the upper extremities, but preserved leg movement and vibratory/light touch sensation in the feet. Most likely diagnosis?

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

Answer: (C)

Central cord syndrome is the pattern you’re looking for here. It typically follows a hyperextension injury to the cervical spine—often in people with some age-related degeneration—and it preferentially injures the central part of the spinal cord where the fibers for the upper extremities are most vulnerable.

The key clues are a dissociated pattern of weakness and sensation: the upper extremities lose pain and temperature sensation, while the legs and most dorsal column–mediated modalities (vibration, light touch, position sense) are relatively spared. Clinically, this fits central cord syndrome, where the central cervical injury damages the crossing spinothalamic fibers and the central corticospinal tracts more for the arms, causing greater weakness in the arms and selective loss of pain/temperature in the arms, with preservation of vibration and proprioception in the lower extremities. If the lesion were confined to the anterior two-thirds, you’d expect motor loss and pain/temperature loss with preserved vibration; if it were a Brown-Séquard pattern, you’d see ipsilateral motor and vibration loss with contralateral pain/temperature loss. A posterior column syndrome would present with loss of vibration and position sense with intact motor and pain sensation. Thus, the presentation aligns best with central cord syndrome.