A 32-year-old man is brought to the emergency department after a motorcycle crash in which witnesses report a severe hyper-extension of his neck. He is alert and hemodynamically stable. Neurologic examination reveals 0/5 strength in both upper extremities and 4/5 strength in both lower extremities. Pin-prick and temperature sensation are diminished in the hands, while proprioception is preserved. Reflexes are brisk in all four limbs. Which incomplete spinal cord syndrome best explains this presentation?
The combination of markedly greater motor weakness in the upper than in the lower extremities, sensory loss predominantly affecting pain and temperature, preserved proprioception, and a hyper-extension cervical mechanism is classic for central cord syndrome. Central cord injuries involve the central corticospinal tracts that contain fibers for the arms situated more medially, producing the characteristic arm-dominant motor deficit. Anterior cord syndrome causes bilateral motor and pain/temperature loss below the lesion with preserved dorsal-column sensation; Brown-Sequard syndrome produces ipsilateral motor loss with contralateral pain/temperature loss; cauda equina syndrome involves lower-motor-neuron leg weakness and saddle anesthesia.
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