Central cord syndrome in cats

JAVMA 2023

February 27, 2025

Carlos Ros, Roberto José-López, Cristina Font, et al.

Background
Central cord syndrome (CCS) is a rare neurological condition characterized by more severe thoracic limb (TL) paresis or plegia compared to pelvic limb (PL) involvement. Though described in dogs, this study investigates CCS in cats, focusing on clinical and neurological findings, etiologies, and outcomes. The authors aim to describe CCS presentation and prognostic factors in feline patients.

Methods
This retrospective study analyzed data from 22 cats diagnosed with CCS across seven referral centers (2017–2021). Clinical records included signalment, examination findings, MRI results, diagnoses, treatments, and follow-ups. CCS was defined as cases where TL deficits exceeded PL deficits. Neuroanatomical localization was assessed and correlated with MRI findings, and outcomes were categorized based on neurological improvement or lack thereof.

Results
-Signalment: Most cats were domestic shorthairs (86.5%), with a median age of 9 years.

-Lesion Location: Neuroanatomical localization was inconsistent with MRI findings in 36.3% of cases. The C2 and C4 vertebrae were the most common lesion sites.

-Onset: CCS signs were peracute in 50% of cases, subacute in 18%, and chronic in 27.5%. Ischemic myelopathy (IM) was the most common peracute etiology (36.3%), while neoplasia was associated with chronic cases (22.7%).

-Outcome: Prognosis was poor in 59% of cases, including all chronic cases. Among cats with good outcomes (41%), most had IM or inflammatory/infectious meningomyelitis.

Limitations
The study's retrospective nature, small sample size, reliance on multicentric data, and lack of long-term follow-up or definitive diagnoses for some cases limit generalizability. The absence of detailed anatomical studies on feline cervical intumescence complicates lesion localization.

Conclusions
CCS in cats can result from lesions in the C1-C5 or C6-T2 spinal cord segments, with ischemic myelopathy and neoplasia being the most common etiologies. Chronic CCS cases, typically associated with neoplasia, have a poorer prognosis than peracute cases. Further research is needed to clarify the anatomical and diagnostic challenges of feline CCS.

Midline sagittal (A) and transverse (B) T2-weighted image (T2WI) MRI in a cat with an intramedullary hyperintense lesion at the level of the C2 vertebral body, suspected to be consistent with ischemic myelopathy (arrow). Midline sagittal (C) and transverse (D) T2WI in a cat with an intramedullary hyperintense lesion suspected to be consistent with a C3-C4 acute noncompressive nucleus pulposus extrusion (arrow). Midline sagittal image (E) and transverse (F) T2WI at the level of C5-C6 IVS in a cat with a diffuse intramedullary hyperintense lesion, suspected to be consistent with meningomyelitis (arrow).

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