58 一位46歲病患駕車在高速公路發生追撞車禍，病人綁安全帶坐在駕駛座，在急診室發現十二指腸破裂緊急接受手術，隔日在病房病人抱怨頸部酸痛且合併手腳麻木現象，頸椎X光攝影並沒有發現骨折，身體檢查與安排MRI攝影懷疑病人有「中心脊髓症候群」（central cord syndrome），請問下列那個敘述對於「中心脊髓症候群」最適當？

病人肌肉無力的神經症狀，上肢比下肢更為明顯

由於合併有脊髓損傷的徵候，因此必須儘快進行減壓手術

「中心脊髓症候群」的預後比起其他的脊髓損傷而言，是最不好的

由於並沒有發現骨折，所以不必讓病人戴頸圈保護頸椎

answer A

Central cord syndrome (CCS), an acute cervical spinal cord injury(SCI), was initially described by Schneider and colleagues in 1954. It is marked by a disproportionately greater impairment of motor function in the upper extremities than in the lower ones, as well as by bladder dysfunction and a variable amount of sensory loss below the level of injury.^1,2,3

Although CCS has been reported to occur with particular frequency among older persons with cervical spondylosis who sustain hyperextension injury, it can be found in persons of any age and can be associated with various etiologies, injury mechanisms, and predisposing factors.² CCS, the pathophysiology of which appears in the image below, is the most common incomplete SCI syndrome.

remember that as the motor nerve ascend from extremities to the brain, the lower extremities occupy the medial zone and the upper extremities occupy the mediolateral zone.

thus when the pincer like injury happened in CCS, the mediolateral are more effected than the medial zone

Pathophysiology

Central cord syndrome (CCS) most often occurs after a hyperextension injury in an individual with long-standing cervical spondylosis. (See also the eMedicine article Cervical Spondylosis.) Injury may result from posterior pinching of the cord by a buckled ligamentum flavum or from anterior compression of the cord by osteophytes.⁵Historically, spinal cord damage was believed to originate from concussion or contusion of the cord with stasis of axoplasmic flow, causing edematous injury rather than destructive hematomyelia. Autopsy studies subsequently demonstrated that CCS may be caused by bleeding into the central part of the cord, portending a less favorable prognosis. Studies have also shown that CCS probably is associated with axonal disruption in the lateral columns at the level of the injury to the spinal cord, with relative preservation of the grey matter.

The syndrome also may be associated with fracture dislocation and compression fracture, especially in a congenitally narrowed spinal canal.⁶ These anteroposterior compressive forces also distribute the greatest damaging effect on the central mass of the cord substance.

CCS-related motor impairment results from the pattern of lamination of the corticospinal and spinothalamic tracts in the spinal cord. Sacral segments are the most lateral, with lumbar, thoracic, and cervical components arranged somatotopically, proceeding medially toward the central canal.

http://en.wikipedia.org/wiki/File:Spinal_cord_tracts_-_English.svg