Central cord syndrome is the most common incomplete traumatic spinal cord lesion. It is characterized by disproportionately greater upper-extremity motor impairment than lower-extremity motor impairment, bladder dysfunction, and variable degree of sensory loss below the level of the injury. This article reports the case of a patient who presented with unilateral weakness after a fall and later developed the typical central cord syndrome. The variability of central cord syndrome has been discussed by other authors, but this is the first case of a patient that initially presented as unilateral weakness.