13. Spinal injuries

Question 1

What symptoms would a P with complete cord transection syndrome display below the level of lesion?

Answer 1

After period of spinal shock, get complete bilateral:

• loss of sensation
• spastic paralysis
• hypereflexia
  i. e. UMN injury

(e.g. paraplegia if thoracic/lumbar injury, tetraplegia if cervical injury)

Question 2

Which autonomic symptoms would a P with complete cord transection syndrome display? Explain why?

Answer 2

Higher lesions cause autonomic dysfunctions: sudden loss of sympathetic input… increased parasympathetic input… vasodilation…

1) decreased TPR… hypotension
2) increased blood flow to penis… priapsim (prolonged sustained erection)

Question 3

Why might there be symptoms of LMN injury in complete cord transection?

Answer 3

1. Initial spinal shock
2. At the level of the lesion, due to local damage to anterior horn cells, adjoining motor roots and nearby sensory roots

E.g. areflexia, flaccid paralysis…

Question 4

Which level would a complete cord transection involve to be associated with acute respiratory collapse?

Answer 4

C3 and above as phrenic nerve function is not preserved (C3, 4 and 5)

Question 5

What is Brown-Sequard syndrome? How would a P present?

Answer 5

Unilateral cord compression/injury (hemisection).

At level of lesion:

1. ipsilateral complete segmental anaesthesia - affects single dermatome due to destruction of dorsal root and dorsal horn
2. ipsilateral LMN signs (e.g. flaccid paralysis, arreflexia) - affects single myotome due to destruction of ventral root

Below level of lesion:

1. ipsilateral paralysis
2. ipsilateral loss of dorsal column modalities (fine touch, vibration and proprioception)
3. contralateral loss of spinothalamic modalities (pain, temperature and crude touch)

Question 6

Describe how a P with anterior cord syndrome would present.

Answer 6

Below level of lesion:

1. bilateral paralysis (corticospinal tract)
2. bilateral loss of pain and temp. sensation (spinothalamic tract)
3. retained proprioception and vibration sensation

+/- autonomic dysfunction

Question 7

Describe how a P with central cord syndrome would present.

Answer 7

1. Motor impairment > sensory impairment
2. Upper body > lower body (e.g. loss of motor functions in arms, incomplete loss of motor function in trunk - cape-like distribution) - as neurones for upper body located more medially in spinothalamic and corticospinal tracts
3. distal areas > proximal areas
4. bladder dysfunction and urinary retention

Question 8

Describe how a P with posterior cord syndrome would present.

Answer 8

Below level of lesion:
1. loss of dorsal column modalities (light touch, vibration sensation, conscious proprioception and 2-point discrimination)

(motor function and spinothalamic modalities preserved)

Question 9

What is syringomyelia and what type of spinal cord injury does it cause? What are the symptoms?

Answer 9

Idiopathic development of a cyst (syrinx) in or beside the central canal, usually in cervical region. Cyst progressively enlarges in all directions.

Causes central cord syndrome:

• initial symptoms arise from obliteration of spinothalamic fibres decussating in ventral white commissure: loss of pain and temp. sensation, often in upper limbs 1st
• fine touch, vibration sensation and proprioception are affected later as cyst enlarges into dorsal columns
• motor losses begin to occur as syrinx extends and damages LMN of anterior horn cells: muscle wasting and weakness begins in hands and then affects forearms and shoulders, tendon reflexes are lost

Question 10

What type of trauma could cause central canal syndrome?

Answer 10

Cervical spine hyperextension in elderly.

Cervical spine hyperflexion in young.

Question 11

Name 2 possible causes for anterior cord syndrome.

Answer 11

1. flexion injury (leading to fractures or dislocations of vertebrae or herniated discs)
2. anterior spinal artery injury, e.g. vascular or atherosclerotic disease in elderly (… ischaemia anterior 2/3 of cord)

Question 12

Which dietary deficiency can cause posterior cord syndrome?

Answer 12

vitamin B12

Question 13

A first responder attends a 23 year old man who has been the victim of a motorcycle crash.
Give four clinical features that may increase the suspicion that the patient has a spinal cord injury.

Answer 13

1. head injury present
2. unconscious or confused
3. spinal tenderness
4. extremity weakness
5. loss of sensation