Which syndrome presents with greater weakness in the upper extremities after a cervical hyperextension?

• A. Anterior Cord Syndrome
• B. Central Cord Syndrome
• C. Brown-Sequard Syndrome
• D. Posterior Column Syndrome

Answer: (B)

Central cord syndrome is the pattern you’re looking for. After a cervical hyperextension injury, especially in someone with degenerative changes, the central portion of the cervical spinal cord is damaged. The fibers that control the upper limbs are located more centrally, so injury there hits the arms more than the legs, leading to disproportionately greater weakness in the upper extremities. Sensory loss can be variable, and you may see a cape-like pattern of pain and temperature loss over the shoulders and arms due to disruption of crossing spinothalamic fibers. In contrast, other syndromes have different hallmark patterns: anterior cord syndrome affects motor and pain/temperature with preserved vibration, Brown-Sequard causes ipsilateral motor and proprioception loss with contralateral pain/temperature loss, and posterior column syndrome chiefly blunts vibration and proprioception with relatively preserved motor function.