3.6 Spinal Cord Injury

Question 1

What kind of information does the spinocerebellar tract carry?

Answer 1

Proprioception

Question 2

Does the spinocerebellar tract provide ipsilateral/contralateral information? Differentiate between the direct/indirect pathways

Answer 2

• Ipsilateral
• Dorsal: no decussation
• Ventral: 2x decussation

Question 3

1° vs 2° spinal cord injury

Answer 3

1°: mechanical injury at time of event

2°: downstream biochemical/physiological processes (minutes/days)

Question 4

Describe spinal fracture dislocation

Answer 4

• Vertebral body dislocates
• Compresses and contuses spinal cord
• Central haemorrhage within the spinal cord

Question 5

Describe spinal burst fractures

Answer 5

• Vertebral body fractures
• Bone fragments compress/contuse spinal cord
• Central spinal cord haemorrhage

Question 6

Where does a spinal haemorrhage begin? Where does it progress, and how long does this take?

Answer 6

• Begins in central grey matter of spinal cord (more vascular)
• Within an hour, it can progress to entire grey matter

Question 7

What are the three main types of movements that can cause spinal cord injury?

Answer 7

• Flexion
• Compression
• Hyperextension

Question 8

The higher the level of a spinal cord injury, the ____ loss of function there is

Answer 8

greater

Question 9

Why might a C3 spinal injury be acutely life threatening?

Answer 9

Loss of phrenic nerve -> impaired breathing -> brain hypoxia -> death

Question 10

Cervical spinal cord injuries typically result in…

Answer 10

Tetraplegia

Question 11

Thoracic spinal cord injuries typically result in…

Answer 11

Paraplegia

Question 12

True or false: lumbar and sacral spinal cord injuries typically regain ambulation with minimal support

Answer 12

True

Question 13

Describe central cord syndrome — what section of the spinal cord does the injury have to be at?

Answer 13

• 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

Question 14

Describe anterior cord syndrome. What kind of injury commonly causes it?

Answer 14

• 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

Question 15

Describe Brown-Sequard sydrome

Answer 15

• 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)

Question 16

List some signs and symptoms of spinal cord injury

Answer 16

• Loss of motor function
• Loss of sensory function
• Exaggerated reflex responses
• Pain/stinging/paresthesia
• Loss of bowel/bladder control
• Sexual dysfunction/fertility issues

Question 17

Thinking about autonomic dysreflexia, what kind of symptoms could it present with?

Answer 17

• Bradycardia
• Hypertension
• Flushed face
• Headache
• Sweating below level of injury

Question 18

Bowel and bladder distension is the most common trigger of autonomic dysreflexia. What is another cause?

Answer 18

Pressure sores.

Question 19

How can blood pressure be lowered in the setting of autonomic dysreflexia?

Answer 19

• Sit patient up
• Pharmacological intervetion

Question 20

If untreated, what are some potential complications of autonomic dysreflexia?

Answer 20

Hypertensive crisis:
- Intracranial haemorrhage
- Detached retina
- Seizures
- Cardiac arrhythmia
- Death