Acute Spinal Cord Injury

Question 1

SCI Incidence

Answer 1

More than 17,000 injuries annually in the United States, mostly young and otherwise healthy, become paraplegic or tetraplegic
Over 1/2 of all spinal cord injuries result in injury above T1
Approximately 1/5 of patients die before reaching the hospital
Spinal cord injury is more common in young males 80%

Question 2

SCI Signs/Symptoms

Answer 2

C4 or above: tetraplegia; may require mechanical ventilation
C4 – C5: tetraplegia; control of head, neck, shoulders, trapezius, and elbow flexion
C5 – C6: tetraplegia; some extension of wrists, index finger and thumb
C6 – C7: elbow extension, capable of feeding, dressing
C7 – T1: Hand movement
T1-T2: Paraplegia; upper chimney control but no trunk control
T3 – T8: some trunk control
T9–10: bowel and bladder reflex, move trunk and upper thigh
T 11- L1: Most leg and some foot movements; ambulation possible
L1-L2: Lower legs, feet in perineum; continued bowel, bladder and sexual dysfunction S2-S4 spinal nerves are involved



Question 3

SCI Lab/Diagnostics

Answer 3

Spinal X-ray series
CT Scan
MRI

Question 4

SCI Management

Answer 4

Referral: neurology/neurosurgery
Methylprednisone 30 mg/kilograms IV bolus, followed by an infusion of 5.4 mg per/kg/hr for 23 hours improves neurological recovery when administered within eight hours of injury; controversial

Question 5

SCI Complications

Answer 5

C4 injury or above: Respiratory compromise
T4-6: May lead to autonomic dysreflexia, an emergency condition
Brown Sequard Syndrome
Cauda equine syndrome
T6 or above: Neurogenic shock may occur

Question 6

Autonomic Dysreflexia

Answer 6

Caused by exaggerative autonomic response to stimulus

Sign/symptoms:
Diaphoresis and flushing above the level of injury
Chills and severe vasoconstriction below the level of injury
Hypertension
Bradycardia
Headache
Nausea

Treatment: stimulus removal and antihypertensive

Question 7

Brown Sequard Syndrome

Answer 7

Cause my damage to 1/2 of the spinal cord

Signs/symptoms:
Ipsilateral upper motor neuron paralysis and loss of proprioception
Contralateral loss of pain and temperature

Treatment: MRI and steroids

Question 8

Cauda Equina Syndrome

Answer 8

Caused by compression of nerves groups at the end of the spinal cord

Signs/symptoms:
Numbness in lower legs, feet, or saddle region

Treatment MRI, steroids, and surgery for decompression

Question 9

Neurogenic Shock

Answer 9

Disruption of transmission of sympathetic impulses caused unopposed parasympathetic stimulation which leads to loss of vasomotor tone, inducing massive vasodilation
Hypovolemia, decreased venous return, and decrease cardio output results
Sympathomimetic vasopressors are used to maintain blood pressure