Central cord syndrome (CCS) is the most common incomplete spinal cord injury syndrome, accounting for approximately 44-70% of all incomplete traumatic cervical spinal cord injuries. It is characterized by a distinctive pattern of motor and sensory deficits: disproportionately greater weakness in the upper extremities compared to the lower extremities, variable sensory loss below the level of injury (often in a cape-like distribution across the shoulders and upper arms), and variable degrees of bladder dysfunction. Understanding the anatomical and pathophysiological basis of this characteristic presentation requires detailed knowledge of the internal organization of the spinal cord, the vascular supply to the central gray and white matter, and the somatotopic arrangement of motor and sensory tracts. The cervical spinal cord is organized with the gray matter centrally (forming the characteristic butterfly or H-shape in cross-section) surrounded by white matter tracts. The lateral corticospinal tract, which carries voluntary motor fibers from the motor cortex to the anterior horn cells, has a precise somatotopic laminar organization: fibers controlling the upper extremities (hands and arms) are located MEDIALLY (closer to the central canal), while fibers...