Acute traumatic central cord syndrome: MRI-pathological correlations

Area of Science:

• Neurology
• Spinal Cord Injury Research
• Radiology

Background:

• Acute traumatic central cord syndrome (ATCCS) is widely believed to stem from central spinal cord injury, often with hemorrhage.
• Pre-existing conditions like spondylosis and canal stenosis are common in ATCCS patients.

Purpose of the Study:

• To investigate the pathological basis of ATCCS by correlating MRI findings with post-mortem examinations.
• To challenge the traditional hypothesis of hemorrhage being a primary feature of ATCCS.

Main Methods:

• Analysis of magnetic resonance images (MRI) from 11 ATCCS patients.
• Correlation of MRI data with gross pathological and histological findings from 3 post-mortem cervical spinal cords.
• MRI studies performed acutely and subacutely post-injury.

Main Results:

• All patients showed hyperintense signals on gradient echo MRI, indicative of white matter injury.
• No MRI or pathological evidence of intramedullary hemorrhage was found.
• Histological examination revealed diffuse axonal disruption, particularly in the lateral columns, with intact central gray matter.

Conclusions:

• ATCCS is primarily a white matter injury, and intramedullary hemorrhage is not a necessary feature.
• The corticospinal tract's role in upper limb motor function is crucial in ATCCS.
• Direct compression from ligamenta flava buckling into a narrowed canal may be the primary injury mechanism.