Systemic lupus erythematosus: a unique cause of central cord syndrome, a case report

Central cord syndrome has classically been defined by disproportionately more motor impairment of the upper than the lower extremities, bladder dysfunction, and varying degrees of sensory loss below the level of the lesion. Review of the literature indicates that the majority of causes of central cord syndrome have a traumatic etiology and few are a consequence of connective tissue disorders. This is a case of a 53-year-old female with systemic lupus erythematosus who developed central cord syndrome due to an exacerbation of her disease. The patient presented with upper extremity motor and sensory deficits but only sensory deficits of the lower extremities. She had laboratory abnormalities consistent with lupus, and magnetic resonance imaging of the cervical spine revealed decreased attenuation from C-1-T-2. High-dose intravenous steroids were started in the acute care hospital with some return of proximal upper extremity strength. Upon transfer to the acute rehabilitation unit, the patient was noted to have neurogenic bladder dysfunction requiring a catheterization program. The patient was slowly tapered down on her oral prednisone with minimal improvement of strength but with return of bladder function. A review of the literature revealed few cases of central cord syndrome secondary to a connective tissue disorder or a non-traumatic etiology.