Acute traumatic central cord syndrome: MRI-pathological correlations

Quencer, Robert M.; Bunge, R P; Egnor, Michael; Green, B. A.; Puckett, William; Naidich, Thomas P.; Post, M. Judith Donovan; Norenberg, Michael D.

doi:10.1007/bf00588148

Cited by 217 publications

(113 citation statements)

References 15 publications

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“…13 It is postulated that injury to these large CST axons may form the basis for hand weakness seen in ATCCS. 1,3 In the current study, we have analyzed morphometrically the number of motor neurons at these levels to determine whether injury to the CST, which has been previously documented after ATCCS, 1 results in motor neuron loss in cervical spinal cord segments which supply hand musculature. In the chronic high level injury (C2), the epicenter of injury was furthest away from the motor neurons supplying hand muscles.…”

Section: Discussionmentioning

confidence: 99%

A histopathological analysis of the human cervical spinal cord in patients with acute traumatic central cord syndrome

2000

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Study design: We have applied conventional histochemical and morphometric techniques to study the changes within the human spinal`hand' motor neuron pool after spinal cord injury in patients who presented with acute traumatic central cord syndrome (ATCCS). Objective: To determine whether a reduction of large alpha motor neurons at the C7, C8 and T1 spinal cord levels underlies the mechanism which causes hand dysfunction seen in patients with (ATCCS). Background: The etiology of upper extremity weakness in ATCCS is debated and injury and/ or degeneration of motor neurons within the central gray matter of the cervical enlargement has been advanced as one potential etiology of hand weakness. Methods: The spinal cords of ®ve individuals with documented clinical evidence of ATCCS and three age-matched controls were obtained. The ATCCS spinal cords were divided into acute/sub-acute (two cases) and chronic (three cases) groups depending on the time to death after their injury; the chronic group was further subdivided according to the epicenter of injury. We counted the motor neurons using light microscopy in 10 randomly selected axial sections at the C7, C8 and T1 spinal cord levels for each group. We also analyzed the lateral and ventral corticospinal tracts (CST) in all groups for evidence of Wallerian degeneration and compared them to controls. Results: A primary injury to the lateral CST was present in each case of ATCCS with evidence of Wallerian degeneration distal to the epicenter of injury. There was minimal Wallerian degeneration within the ventral corticospinal tracts. In the chronic low cervical injury group, there was a decrease in motor neurons supplying hand musculature relative to the other injury groups where the motor neurons sampled at the time of death were not reduced in number when compared to the control group. Conclusions: We hypothesize that hand dysfunction in ATCCS can be observed after spinal cord injury without any apparent loss in the number of motor neurons supplying the hand musculature as seen in our acute/sub-acute (n=2) and our chronic high injury (n=1) groups. The motor neuron loss seen in the chronic low level injury was felt to be secondary to the loss of C7, C8, and T1 neurons adjacent to the injury epicenter. Spinal Cord (2000) 38, 532 ± 537

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Section: Discussionmentioning

confidence: 99%

A histopathological analysis of the human cervical spinal cord in patients with acute traumatic central cord syndrome

2000

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“…Three of these injuries displayed no central hematomyelia but showed preferential di use axonal disruption in the lateral tracts. Quencer 15 in the same study looked only at central cord injuries and again found the same pattern of injury in milder cord traumas. Only the more severely injured spinal cord displayed central hemorrhage.…”

Section: Discussionmentioning

confidence: 69%

“…Studies on monkey spinal cords by Barnard, 10 Nathan, 11 Coxe, 12 and Pappas 13 analyzed the degeneration of selective ®ber tracts from cortex or subcortex and showed that arm ®bers within the corticospinal tract are di usely intermingled with leg ®bers. Bunge 14 and Quencer 15 examined cases of cervical trauma that showed di use axonal loss within lateral columns rather than central injury.…”

Section: Discussionmentioning

confidence: 99%

Cruciate paralysis, hypothesis for injury and recovery

Bryce

Marino

2000

Spinal Cord

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Study Design: Case report and review of the literature. Objectives: Discuss a case of cruciate paralysis, a review of the literature and the hypotheses regarding the pathogenesis and recovery in spinal cord injuries that cause disproportionate weakness of the upper extremities. Setting: Thomas Je erson University Hospital, Philadelphia, PA, USA. Methods: Case report. Results: A case of cruciate paralysis is presented involving a 59-year-old female who experienced a gunshot wound to the face. Initial motor exams revealed mild lower limb weakness and absent upper limb function with an upper limb modi®ed American Spinal Injury Association motor score of 0/50 (a modi®ed impairment scale using half point muscle grades). Spinal imaging revealed fractures of the C1 anterior ring and the odontoid process, both associated with multiple bullet fragments. No spinal surgery was performed and she was placed in halo ®xation. By 3 weeks she had regained enough upper limb function to manipulate large objects with her left hand and move her right hand. At that time, her upper limb ASIA score was 16/50. By 5 weeks, her upper limb modi®ed ASIA motor score had improved to 31.5/50 and she began manipulating feeding utensils, writing legibly, and brushing her teeth with her left hand. Conclusions: In this case report we present a patient's motor and functional recovery. We also discuss the hypothesis that the acute central cord syndrome and cruciate paralysis are a likely result of similar pathologic mechanisms and that good functional outcome resulted from an initially disabling trauma. Spinal Cord (2000) 38, 120 ± 125

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“…In the recent past, the historical report of Schneider et al 1 has been challenged. Not only have the original descriptions of pathogenesis and neuroanatomical basis of TCCS been criticized, [7][8][9][10][11] but optimal treatment of the condition has also been reappraised. 3,[12][13][14][15][16] This survey study challenges the ambiguity of the TCCS definition as introduced by Schneider et al Whereas several physicians assign a diagnosis of TCCS in SCI patients with only 1 motor score point lower in the upper extremities than in the lower extremities, other physicians consider patients with a minimum difference of 15 points as TCCS patients.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic criteria of traumatic central cord syndrome. Part 2: A Questionnaire Survey among Spine Specialists

et al. 2010

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Study design: A questionnaire survey. Objectives: To evaluate the need for the introduction of quantitative diagnostic criteria for the traumatic central cord syndrome (TCCS). Setting: An online questionnaire survey with participants from all over the world. Methods: An invitation to participate in an eight-item online survey questionnaire was sent to surgeon members of AOSpine International. Results: Out of 3340 invited professionals, 157 surgeons (5%) from 41 countries completed the survey. Whereas most of the respondents (75%) described greater impairment of the upper extremities than of the lower extremities in their own TCCS definitions, symptoms such as sensory deficit (39%) and bladder dysfunctions (24%) were reported less frequently. Initially, any difference in motor strength between the upper and lower extremities was considered most frequently (23%) as a 'disproportionate' difference in power. However, after presenting literature review findings, the majority of surgeons (61%) considered a proposed difference of at least 10 points of power (based on the Medical Research Council scale) in favor of the lower extremities as an acceptable cutoff criterion for a diagnosis of TCCS. Most of the participants (40%) felt that applying a single criterion to the diagnosis of TCCS is insufficient for research purposes. Conclusion: Various definitions of TCCS were used by physicians involved in the spinal trauma care. The authors consider a difference of at least 10 motor score points between upper and lower extremity power a clear diagnostic criterion. For clinical research purposes, this diagnostic criterion can be considered as a face valid addendum to the commonly applied TCCS definition as introduced by Schneider et al.

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Acute traumatic central cord syndrome: MRI-pathological correlations

Cited by 217 publications

References 15 publications

A histopathological analysis of the human cervical spinal cord in patients with acute traumatic central cord syndrome

A histopathological analysis of the human cervical spinal cord in patients with acute traumatic central cord syndrome

Cruciate paralysis, hypothesis for injury and recovery

Diagnostic criteria of traumatic central cord syndrome. Part 2: A Questionnaire Survey among Spine Specialists

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