Central cord syndrome from blast injury after gunshot wound to the spine: a case report and a review of the literature.

Abstract

Central Cord Syndrome (CCS) is the most common of the spinal cord injury syndromes. Few cases have been presented with gunshot wound (GSW) as a cause of a central cord syndrome, and none, to our knowledge, has been presented without any evidence of central canal bullet/bone fragments. A 27-year-old male suffered two close-range gunshot wounds, one to the left neck and one to the left shoulder. CT scan showed C5 spinous process fracture and paraspinal muscle hemorrhage without evidence of central canal stenosis or bullet/bone fragments. Physical examination showed severe weakness and dysesthesias in bilateral upper extremities and mild weakness in bilateral lower extremities. Diagnosis of central cord syndrome was made. He was treated conservatively and started inpatient rehabilitation. Four months post injury, the patient had almost full recovery with only left proximal arm and bilateral distal hand weakness. Only four cases of CCS caused by GSW have been reported in the literature. Some suggested algorithms exist regarding the management of these patients, but still cases should be individualized depending on the specific nature of their presentation. The prognosis for patients with CCS tends to be favorable in regaining sensory, bladder, bowel, gross motor function and ambulation, but fine motor skills may remain impaired.