3.2- Spinal Cord Syndromes

Question 1

What is injury to exactly ½ of the SC (right or left)?

Answer 1

Brown-Sequard Syndrome

Question 2

What is very rare- due to violence (gun or knife)?

Answer 2

Brown-Sequard Syndrome

Question 3

Brown-Sequard Syndrome affects ____________on side of lesion.

Answer 3

both white and gray matter

Question 4

Brown-Sequard Syndrome causes what symptoms in the Dorsal Column (white matter)?

Answer 4

loss of light discriminating touch, kinesthetic sense, and vibration on the same side of the lesion (does not cross until the brain)

Question 5

Brown-Sequard Syndrome causes what symptoms in the Lateral Column- contains Lateral Spinothalamic tract?

Answer 5

loss of pain and temp on the opposite side (crosses at same level)

Question 6

Brown-Sequard Syndrome causes what symptoms in Lateral Corticospinal tract?

Answer 6

loss of upper motor neuron on same side (crosses in brain)

results in spastic paralysis on same side- hypertonic and hyperreflexic

Question 7

Brown-Sequard Syndrome-
cell bodies contained in the ____ are damaged at just that level of trauma, so the affects of cell body loss will be seen at just that level

Answer 7

gray matter

Question 8

Brown-Sequard Syndrome causes what symptoms in the dorsal horn? ventral horn?

Answer 8

dorsal horn- complete anesthesia same side in just that dermatome

ventral horn- flaccid in that myotome due to destroyed alpha motor neurons (hypotonic, areflexia just at that level)

Question 9

What syndrome is anterior 2/3 of spinal cord affected bilaterally?

Answer 9

Anterior Cord Syndrome

Question 10

Anterior Cord Syndrome is very common. It is often seen with ____ injury to the neck damaging the ____ directly or _____ artery.

Answer 10

flexion injury

damaging the anterior cord directly or anterior spinal artery

Question 11

Anterior Cord Syndrome causes what symptoms in the lateral column?

Answer 11

damaged bilaterally

lose pain, temp, crude touch bilaterally below lesion

Question 12

Anterior Cord Syndrome causes what symptoms in the Lateral Corticospinal Tract?

Answer 12

damaged bilaterally

spastic paralysis bilateral

Question 13

Anterior Cord Syndrome causes what symptoms in the cell bodies of gray matter?

Answer 13

damaged bilaterally

flaccid paralysis in myotome of lesion level bilaterally

Question 14

Anterior Cord Syndrome does not affect what spinal structure? What symptoms are left intact?

Answer 14

dorsal column

light touch, vibration, kinesthesia intact

Question 15

What is the most common spinal cord syndrome?

Answer 15

Central Cord Syndrome

Question 16

Central Cord Syndrome affects what area?

Symptoms are not as clear cut.

Answer 16

“middle” of cord affected- starts centrally and spreads out

Question 17

What is usually result of progressive stenosis or compression from a hyperextension injury (bleeding into the gray matter produces the damage)?

Answer 17

Central Cord Syndrome

Question 18

Central Cord Syndrome typically affects ___ more than ___. Why?

Answer 18

Typically affects UE’s more than LE’s b/c the cervical tracts/UE tracts are deeper than LE and sacral tracts

Question 19

Central Cord Syndrome causes what symptoms in the dorsal column?

Answer 19

(light touch and kinesthetic)

variable results with UE’s (deeper) affected before LE’s

can cause “Cape Analgesia”

Question 20

What is “Cape Analgesia”? What syndrome is this associated with? What spinal structure?

Answer 20

bilateral decreased sensation in a “cape” pattern

associated with Central Cord Syndrome

Dorsal Column

Question 21

Central Cord Syndrome causes what symptoms in the lateral column?

Answer 21

(pain and temp)

generally not affected b/c where it is located except at the level of the lesion bilaterally (remember this is where these fibers cross to the other side- do so through the middle of the cord)

Question 22

Central Cord Syndrome causes what symptoms in the Lateral Corticospinal Tract?

Answer 22

(motor)

will have bilateral spastic paralysis in UE’s (deeper) but not necessarily LE’s (b/c of layering)

Question 23

Central Cord Syndrome causes what symptoms in the cell bodies of gray matter?

Answer 23

flaccid paralysis bilaterally at level of lesion

Question 24

What syndrome is posterior 1/3 of SC injured due to compression of the Posterior Spinal Artery? (This syndrome has 2 names)

Answer 24

Dorsal Column Syndrome

Posterior Cord Syndrome

Question 25

What syndrome is very rare- due to tumor or vascular problem?

Answer 25

Dorsal Column Syndrome sometimes both of these arteries are blocked, but usually its just 1

Question 26

What symptoms result from the dorsal column in Dorsal Column Syndrome?

Answer 26

(light touch, kinesthesia) lost below level of lesion- bilateral if both arteries are affected and same side if only 1 affected

Question 27

What symptoms result from the lateral column in Dorsal Column Syndrome?

Answer 27

(pain and temp) not affected

Question 28

What symptoms result from the Lateral Corticospinal Tract in Dorsal Column Syndrome? Cell bodies of gray matter?

Answer 28

motor is generally not affected generally not affected

Question 29

More than 50% of SC injuries are ______ injuries because victims are being immobilized better before transport to the hospital.

Answer 29

incomplete injuries

Question 30

What is Sacral Sparing?

Answer 30

the sacral fibers run the most medially so they are often spared in incomplete injuries good for client b/c they retain bowel and bladder control

Question 31

``` Function depends on level of injury. UE- level dictates remaining function C3, C4, C5: C5: C6: C7: C8: ```

Answer 31

``` C3, C4, C5: diaphragm and upper trap C5: deltoid and biceps C6: wrist extensors C7: triceps, lats C8: finger flexors ```

Question 32

``` Function depends on level of injury. LE- ambulation is always client’s concern. L2: L3: L4: L5: S3, S4, S5: ```

Answer 32

``` L2: hip flexors (psoas) L3: knee ext L4: ankle dorsiflexors L5: great toe ext (extensor halluces) S3, S4, S5: bladder, bowel, sex organs ```

Question 33

A ______ injury requires vent, full time help, sip and puff wheelchair.

Answer 33

C1-C3

Question 34

A _____ injury allows independent living b/c triceps help with transfers, pressure relief, and self-stretching.

Answer 34

C7

Question 35

A ____ injury requires power wheelchair with mouth stick or chin control, mechanical ventilation (maybe only part of the time), full time help.

Answer 35

C4

Question 36

A ____ injury requires power chair with hand controls, manual chair with rim projections, Max Assist transfers, independent pressure relief, help setting up self-care activities.

Answer 36

C5

Question 37

A ____ injury requires independent sliding board transfers, independent manual wheelchair with rim projections, drive with hand controls, independent feeding with adaptive equipment, independent rolling.

Answer 37

C6

Question 38

A ____ injury requires independent pulling into standing in parallel bars and use of long leg braces (community ambulation).

Answer 38

L1-L2

Question 39

A ____ injury requires swing through gait with crunches and long leg braces. Able to do curbs and may still use wheelchair b/c of energy and speed considerations.

Answer 39

L3-L5

Question 40

A ____ injury- | bracing not as extensive (hinged AFO)

Answer 40

sacral