3.6 Spinal Cord Injury Flashcards
What kind of information does the spinocerebellar tract carry?
Proprioception
Does the spinocerebellar tract provide ipsilateral/contralateral information? Differentiate between the direct/indirect pathways
- Ipsilateral
- Dorsal: no decussation
- Ventral: 2x decussation
1° vs 2° spinal cord injury
1°: mechanical injury at time of event
2°: downstream biochemical/physiological processes (minutes/days)
Describe spinal fracture dislocation
- Vertebral body dislocates
- Compresses and contuses spinal cord
- Central haemorrhage within the spinal cord
Describe spinal burst fractures
- Vertebral body fractures
- Bone fragments compress/contuse spinal cord
- Central spinal cord haemorrhage
Where does a spinal haemorrhage begin? Where does it progress, and how long does this take?
- Begins in central grey matter of spinal cord (more vascular)
- Within an hour, it can progress to entire grey matter
What are the three main types of movements that can cause spinal cord injury?
- Flexion
- Compression
- Hyperextension
The higher the level of a spinal cord injury, the ____ loss of function there is
greater
Why might a C3 spinal injury be acutely life threatening?
Loss of phrenic nerve -> impaired breathing -> brain hypoxia -> death
Cervical spinal cord injuries typically result in…
Tetraplegia
Thoracic spinal cord injuries typically result in…
Paraplegia
True or false: lumbar and sacral spinal cord injuries typically regain ambulation with minimal support
True
Describe central cord syndrome — what section of the spinal cord does the injury have to be at?
- Cervical injury
- Ischaemia, haemorrhage or necrosis in the central spinal cord
- Corticospinal tracts are spared due to lateral location; lower limbs are fine
- However, the second order neuronal cell bodies for upper limbs are damaged, so upper limb movement is lost
Describe anterior cord syndrome. What kind of injury commonly causes it?
- Commonly caused by flexion injuries
- Trauma/loss of blood supply to anterior spinal cord
- DCML is spared (fine touch, proprioception, vibration)
- Motor function (corticospinal) and pain/temp/crude touch/pressure (spinothalamic) is lost
Remember: anterior spinal artery supplies anterior 2/3; makes sense that only D
Describe Brown-Sequard sydrome
- Damage on one side of the spinal cord
- Ipsilateral DCML and Corticospinal loss (since these decussate in the brainstem)
- Contralateral spinothalamic loss (since these immediately decussate)
List some signs and symptoms of spinal cord injury
- Loss of motor function
- Loss of sensory function
- Exaggerated reflex responses
- Pain/stinging/paresthesia
- Loss of bowel/bladder control
- Sexual dysfunction/fertility issues
Thinking about autonomic dysreflexia, what kind of symptoms could it present with?
- Bradycardia
- Hypertension
- Flushed face
- Headache
- Sweating below level of injury
Bowel and bladder distension is the most common trigger of autonomic dysreflexia. What is another cause?
Pressure sores.
How can blood pressure be lowered in the setting of autonomic dysreflexia?
- Sit patient up
- Pharmacological intervetion
If untreated, what are some potential complications of autonomic dysreflexia?
Hypertensive crisis:
- Intracranial haemorrhage
- Detached retina
- Seizures
- Cardiac arrhythmia
- Death