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PM&R Secrets 3rd Ed > Ch. 55 Spinal Cord Injury > Flashcards

Ch. 55 Spinal Cord Injury Flashcards

1
Q

Whats is the initial management of spinal cord injury patient?

A 
Acute management:
ABC
Stabilization neutral position
Plain xray entire spine
Neurogenic shock: Isotonic IV Fluids – Foley Cath.
IV Methylprednisolone.
DVT prophylaxis.
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2
Q

Describe the tracts in spinal cord.

A 
Ascending (Sensory)
1. Dorsal Column (SLTC)
Posterior > Deep touch, proprioception and vibration.
2. Spinothalamic (CTLS)
Ventral > Light Touch
Lateral > Pain and Temp

Descending (Motor):
1. Corticospinal >Lateral - Ventral

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3
Q

Can patient present with neurological deficit with normal imaging?

A

Spinal cord injury without radiographic abnormality

  • Pediatrics:
    Breech presentation – violent hyperextension/flexion.
  • Adult:
    After head trauma – neck pain
    Neck imaging with flexion/extension after clearing any pain or neurological symptoms.
    May present with delayed paralysis after edema!
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4
Q

How can near by structure affect nerve roots?

A
  1. Facet Joint > Bone Spur
  2. Disc > Herniation
  3. Thick Ligamentum Falvum (SCIWORA)
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5
Q

Describe the blood supply to the spinal cord?

A

Thorasic aorta > Posterior intercostal artery
A) Antrior radicular > Artery of adamkiewicz > Anterior spinal artery
B) Post radicular artery > Posterior spinal artery

Artery of Adamkiewicz: major blood supply to the lumbar and sacral cord (lower 2/3 of the spinal cord, T9–L3)

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6
Q

SCI Syndroms

A

Anterior Cord:
- Below level both motor and sensory deficit except for proprioception/vibration/deep touch (dorsal/posterior column)

Posterior Cord:
- Below level motor function is reversed, but deficit in proprioception/vibration/deep touch (dorsal/posterior column)

Central Cord:

  • Spinal stenosis.
  • Greater deficit in Upper body > Lower body.
  • Upper body mix motor and sensory.
  • Lower body lower sensory.

Brown Sequared:

  • Ipsilateral hemiplegia
  • Contralateral hemianasthesia
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7
Q

If patient presented with SCI, how do you classify them?

A

Asia impairment scale

Complete Asia A: No sensory or motor below
Incomplete Asia B: Sensory S5/4, no motor
Incomplete Asia C: Sensory S5/4, motor <3
Incomplete Asia D: Sensory S5/4, motor >3
Incomplete Asia E: Normal

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8
Q

What key muscles are examined in SCI

A

Key muscles:

C5 Elbow flexors
C6 Wrist extensor 
C7 Elbow extensor
C8 FDP DIP middle finger 
T1 Abduction little finger 
L2 Hip flexors
L3 Knee Extensor
L4 Ankle dorsiflexion
L5 Big toe extensor 
S1 Ankle planter flexion  
S5 Voluntary anal contraction
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9
Q

What are the most disability after SCI

A 
Shoulder adduction
Elbow flexion
Tenodesis
Wrist flexion, finger extension
Wrist extension, finger flexion
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10
Q

Requirement for ambulation

How do you test is in your examination?

A

Hip flexion 3/5 bilateral

Knee extension 3/5 unilateral

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11
Q

SCI patient develops high bp 190/100, bradycardia 50bpm and sweating.

A

Autonomic dy(s)reflexia (six)

  • Lesion above T6 affect central regulation of sympathetic discharge.
  • Result in hyperactive reflex sympathetic discharge and corrective parasympathetic outflow from vagus nerve to reduce HR and contractility.
  1. Look for any noxious stimulation: UTI, stone, bowel impaction, pressure sore or ingrown nail.
  2. SBP > 160 mmHg : Nitropaste patch above SCI level + Capoten.
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12
Q

SCI patient presented with anorexia, restless, spastic.

What should you rule out?

A

Acute abdomen in sci

Examination:
Above T5 : negative
T6-T10 : may be tender
Below T12 : normal sensation > tender

Septic markers
AXR, U/S, CT are helpfull

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13
Q

Why DVT are increase after SCI?

A

Virchow triad

  1. Hyper coagulability (tumor, trauma, medical)
  2. Venous Stasis (paralysis)
  3. Endothelial damage (trauma)
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14
Q

SCI patient presented with chronic back pain. What comes in your mind as spine pathology in those patients?

A

Charcot spine > Tables dorsalis

  • Syphilitic changes in posterior column deterioration
  • destructive osteoarthropathy
  • Present with chronic pain and autonomic dysreflexia
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15
Q

After SCI, patient complain about lethargy and abdominal cramps ?

A

“Painfulbones, renalstones,abdominal groans, and psychicmoans” Order corrected calcium!

Treatment:

  1. Mobilization
  2. Hydration
  3. Lasix (Furosemide)
  4. Calcitonin
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16
Q

46yo SCI patient c/o breathless and sweating.

A

Routine labs: CBC, BioChem, septic w/u, cardiac enzymes
Examination: Vitals, ECG

SCI have greater risk of CAD:

  1. Inactivity
  2. Hyperglycemia
  3. Obesity
17
Q

Complication of sci as of aging? (bed ridden)

A
  1. UTI
  2. Pneumonia
  3. Pressure ulcer
  4. Physical inactivity
  5. Metabolic syndrome
18
Q

What are the causes of SCI

A

36.5% motor vehicle crashes (MVCs)
28.5% falls
14% violence (most are gunshot wounds)
9% sports (most common is diving)

19
Q

What are the common types of SCI in the last decade?

A

C5 is overall the most common level of injury.
T12 is the most common level of injury of paraplegia.

  1. 6% incomplete tetraplegia.
  2. 7% incomplete paraplegia.
  3. 0% complete tetraplegia.
  4. 6% complete paraplegia.
20
Q

Return to work post-injury

A

The higher the level and more severe the injury, the less likely to return to employment.

■ Younger age
■ Male
■ Married,
■ Greater education
■ Ability to drive/ambulate
21
Q

Predictors of mortality after injury include:

A 
Patient:
■ Male gender
■ Advanced age
■ Ventilator dependent
■ High injury level (particularly C4 or above)
■ Neurological complete injury

Psychosocial:
■ Poor community integration
■ Poor economic status indicators
■ Medicare care

22
Q

Causes of death after SCI

A
  • Respiratory disorders (pneumonia)
  • Heart disease
  • Sepsis
  • Suicide
23
Q

Corticospinal tracts

1) Function
2) Pathway
3) Lesion

A

1) Voluntary muscle activity.
2) Precentral gyrus of the frontal lobe of the brain > internal capsule > medulla oblongata. (80% pyramidal decussation) > lateral corticospinal tracts > ventral horn (UMN) > secondary neuron (LMN)
3) Hemiplegia/paresis contralateral side

24
Q

Spinocerebellar tracts

1) Function
2) Pathway
3) Lesion

A

1) Control posture and coordination
2) Transmit unconscious proprioception (muscle proprioceptive) > carries information from muscle spindles, Golgi tendon > cerebellum
3) Ipsilateral ataxia

25
Q

Spinothalamic tracts

1) Function
2) Pathway
3) Lesion

A

1) Transmit pain and temperature from the contralateral side of the body.
2) dorsal horn of the gray matter > cross opposite within 1 to 3 vertebral > thalamus on the opposite side > internal capsule > postcentral gyrus of the cerebral cortex.
3) loss of pain-temperature sensation
contralaterally below the level of the lesion.

26
Q

Dorsal (posterior) columns

1) Function
2) Pathway
3) Lesion

A

1) proprioception, fine touch, and vibration sense from the ipsilateral side of the body.
2) sensory fibers > dorsal root ganglion (DRG) > ipsilateral dorsal white columns > medulla (decussate) > medial lemniscus > postcentral gyrus.
Fasciculus gracilis > sacral and lumbar levels are situated in the medial part
Fasciculus cuneatus > thoracic and cervical levels are situated in the lateral part of the column
3) loss of proprioception and vibration ipsilaterally below the level of the lesion.

27
Q

What is the watershed area in spinal cord?

What its significant?

A
  • lower thoracic region, because there are fewer

radicular arteries that supply the mid thoracic region of the spinal cord.

PM&R Secrets 3rd Ed (7 decks)

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