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    Central Cord Syndrome

    4 months ago I fell down stairs and through the MRI was diagnosed as central cord syndrome or neck hyperextension. I was in hospital for 2 weeks with urinary retention, and weak arms.

    I have seen a different neurosurgeon since hospital who thinks I may have brachial plexus injury as well and thinks the central cord injury has recovered fully as my hands are/were fine(usually central cord affects hands)and my bladder/bowel/legs were all normal after 6 weeks. but my problem is solely deltoids/biceps shoulder girdle. Apparently it is very uncommon for central cord syndrome to affect proximal muscles only. BUT another neurosurgeon has told me it can't be brachial as sensation is usually impaired with brachial and my sensation is fine except for back of shoulder where I can't distinguish pinprick.

    ANyhow I hate to ask soo many questions but my biceps/deltoids are a grade 3 on the right. What are the chances of them moving up more grades..The left unfortunately I amn't sure if they are even innervated. Its soo hard to get information on central cord syndrome. Any information I would appreciate.

    #2
    aurelia,

    The constellation of symptoms that you describe may be explained by the spinal cord injury, root injury, or brachial plexus injury. It is possible that a partial injury of the upper part of the brachial plexus or spinal roots can produce localized loss of sensation in the shoulder girdle. In general, however, this should be one-sided because the probability that you would get the same location and degree of brachial plexus or spinal root injury on both sides is low. If your sensory loss is midline and distributed on both sides, then it is likely to be related to spinal cord injury.

    Your biceps weakness, especially if it is bilateral, is very likely to be due to gray matter damage at C4/5. It is likely to recover to some extent because even 10-20% of the motoneurons will eventually expand their innervation to activate more muscles. To ensure this, however, you need to do systematic exercises. I think that you would be a good candidate for biofeedback therapy as well.

    Wise.

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      #3
      Thanks for your prompt reply. Yes the weakness is bilateral, just a lot worse on the left side but affecting the same muscle group (deltoids and biceps) on both sides and yes the MRI showed up a swelling on C4/C5/C6. Will continue with exercises..I have improved somewhat but am keeping fingers crossed (as well as exercising) that more strength will come back to deltoids. Must look up biofeedback to see does anyone do it here in Ireland...or if there is a program in Seattle as my sister is over there.

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        #4
        Aurelia, I have done some biofeedback for my right hand with an occupational therapist at the University of Washington in Seattle. While in my case, the biofeedback didn't do much, I have gotten some recovery in the hand from exercise and electrical stimulation.

        The UW has an excellent SCI rehab with a very knowledgeble and experienced staff. They have gotten me from firmly rooted in a wheelchair to functional walking. My injury is C6.

        I'd be happy to answer any questions you may have about them.

        - Bruce

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          #5
          Thanks for the information projectorguy. I have done more research into biofeedback and I amn't getting a lot of positive stuff to convince me to leave Ireland to try it. Went to nerve conductor tests today and left biceps/deltoids are not innervated and surgeon thinks its a nerve root problem which would make it peripheral altho this would be a bit strange as the injury is bilateral. Luckily right side is a lot stronger. Not sure if they are going to do brachial plexus exploration. Good to hear about your recovery, what electrical stimulation do you use..it is the neurotransmitter machines.
          Thanks..

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            #6
            Aurelia, for my e-stim I use a portable unit i got over the internet at paintechnology.com. Mine is the EMS 1000 Plus. The digital unit is a new model. It's not hugely powerful but, by using both channels and four electrodes, I was able to get my right hamstring going again. I'm now working on my right dorsiflexor which lifts my foot when walking. One channel has plenty of power for my hand muscles, however. I tend to use a pattern of about ten seconds on, ten seconds off. You will have to experiment with the frequency of the signal for best results.

            They also have TENS units, but those are used for pain management, and should be avoided for e-stimming of muscles.

            - Bruce

            Comment


              #7
              Dr.Wise

              Again I would just love your opinion on this but I have been originally diagnosed central cord syndrome with no innervation of biceps/deltoids on left side, they are working on right but are very weak a grade 3. Breathing is fine. My symptoms happened after I fell down stairs but I got up and walked and about 10 mins later I saw a big flash (spinal stroke?) and my legs went from underneath me and I had urinary incontinence. My legs came back fully in 24 hours and urinary came back in 10 days. Arms remained impaired. MRI showed up C4/5/6 swelling.

              The neurosurgeon agrees my left side may be brachial injury and is going to send me for a brachial exploration where they open me up and then if nerves are avulsed c5c6 or very badly stretched they will divert nerves from intercoastal muscles in ribs or sural nerve in leg to innervate biceps. Now if they open me up and find no root/brachial injury (in other words its definitely central cord) can they go ahead and with this op in any event to innervate biceps. Also is it possible to have an ischemia/stroke at just one level and I have blown all the grey cells at C5 as the flash and the instant losing of legs are symptoms of spinal stroke

              Comment


                #8
                Aurelia, sorry that I did not respond earlier. I took a look, started a post, but never finished it. You have a very complicated situation here and I need a little time to think about it before responding. Will do so in a day or so. Wise.

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                  #9
                  Take your time...thanks a million. You did already answer my earlier query.

                  Comment


                    #10
                    Aurelia, will you be getting your surgery at Stanmore (the Royal National Orthopedic Hospital at Stanmore in London) with Dr. Carlstedt? He has published a large series of cases reimplanting brachial plexus avulsed nerves into the spinal cord. He says that they typically will not wait more than 3 months after the accident.

                    Regarding your "central cord syndrome" and spinal stroke, I find your description of a "flash" to be very interesting. It is the first time I have heard of such a description. Ischemia tends to be slower (i.e. over minutes, rather than seconds). I have been doing a literature search to see if there are any other examples that have been reported. My first impression from your description is that your primary injury is from trauma and that you may have had a second trauma (because your spinal column was unstable). Many football players experience such a "flash" when their spinal cords are bruised. They even have a name for it. They call it a "stinger" or "burner". They are frequently paralyzed for several minutes or even hours afterwards.

                    Have you had any studies of your peripheral nerve to see whether where the conduction stops? Also, do you have neuropathic pain (on the left side)? If you don't have neuropathic pain, it would argue against a brachial plexus avulsion but a regular central cord syndrome.

                    If you just have a central cord syndrome, I predict that you will have substantial recovery in the coming months. This would be particularly true if you receive high-dose methylprednisolone shortly after your initial injury (i.e. within 6 hours, the earlier the better?). I know a number of people with central cord syndrome that have recovered almost completely but it may take a year or two for the arms to come back completely.

                    So, anyway, that was what I was thinking. Let me think some more and then post later.

                    Wise.

                    Comment


                      #11
                      Thanks a million again for prompt reply, I do think too I have 2 injuries going on...It is going to be Stanmore with Dr. Carlstedt or Dr. Birch. As far as I know they would prefer to operate during first 3 months for optimal results but they can operate up to 8, the results just aren't as good. I am 5 months post injury. Yes the flash was sudden, a second, a large flash in the back of my neck (altho how I could have seen it in the back of my neck is beyond me) and I immediately fell over and lost control of my legs.

                      I have had nerve conduction studies and the conduction stops at the spine. It showed no voluntary motor recruitment on left side. I have no neuropathic pain which I know goes hand in hand with brachial injuries but they have said the nerves may not be avulsed but just very badly stretched. I did 't receive methylprednisolone until about 72 or more hours later but I have had some recovery in right arm and it continues to improve. The left is being left behind.

                      I am confused as the deltoids are innervated by C4/C5 along with the diaphragm partially at C4 and surely if I have soo much de-enervation at C4/c5 on left hand side.. the grey cell damage at this level should have at least partially affected my breathing which is why it makes me think it is more of a root injury.

                      Anyhow I just figured even if it was Central Cord Syndrome they might still be able to treat it as Brachial and get back even a weak biceps as time goes on and muscles remain deenervated it gets unlikely for spontaneous recovery. Thanks again for all your help. Sorry for all confusing details.

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                        #12
                        Your interests are astrology? You sound like a doctor. You know a lot of anatomy! Wise.

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                          #13
                          Ha...it has become anatomy or probably shoulder anatomy since my injury altho I have to say there was an interesting accident constellation showing in my astrology chart around the time I had injury. Maybe it was fated. I have been told by friends/family to try to speak a sentence without the word deltoid in it.

                          Comment


                            #14
                            Okay my surgeon has got a letter from Mr Birch saying he thinks I don't have a brachial plexus but rather have been provoked by a ischaemia of the anterior part of the cord from interscalene brachial plexus block. Is this a shortcut way of saying I have central cord syndrome as original diagnosed I wonder.

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                              #15
                              Aurelia, I am sorry but I am not sure that I understand the part of the interscalene brachial plexus block and what that has to do with ischemia of the anterior cord. None of these would imply central cord syndrome. Wise.

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