Classification and syndromes Flashcards
non-traumatic injuries
infections (polio), vascular lesions or inflammatory disorders, diseases or degeneration (MS, DDD), congenital anomalies, psychological causes (hysterical paralysis), neoplasms, CVA in spinal cord
Transverse Myelitis
common inflammatory disorder
F to M 4:1
progresses over period of 48 hr- weeks
50% have paralysis, all have neurogenic bladder, 80-95% have sensory problems
prognosis: 1/3 recover, 1/3 have paraplegia, 1/3 have some neuro deficits
Traumatic SCI stats
12,000 new US per year
average age 33 but mainly 16-30 yo
caucasian>AA>hispanic
Less SCI are complete today vs incomplete
Many d/c home and life expectancy is shortened
Spinal cord segments
31 pairs
C1-7 above corresponding vertebra
C8 down exit below corresponding vertebra
8C, 12T, 5L, 5S, 1Coccygeal
spinal cord cross section
dorsal nerve root= sensory, anterior= motor
gray matter= cell bodies
white= axons, tracts
conus medullaris
termination of SC at L1-2 vertebra
filum terminale
attaches SC to coccyx
cauda equina
get more LMN injury or peripheral N injury
Vertebra bone
Know location of vertebral canal, spinous process, transverse process, lamina, pedicle, facet joint
Ligaments
Know ALA lig and transverse ligament of atlas
blood supply
1 anterior spinal artery and 2 posterior spinal arteries
corticospinal tract
descending; voluntary mvt ms, 90% crosses in medulla; 10% doesn’t cross
vestibulospinal tract
descends ipsilaterally; posture and head stability
reticulospinal tract
descending; RAS in brainstem; ventral ipsilateral extension mvt; lateral ipsi and contralateral ms tone
rubrospinal tract
descending; facilitates flexion UE
tectospinal tract
descending; reflex posture, mvt head, coordinates head/eye mvt
spinothalamic tract
ascending; lateral pain/temp, ascends 2-4 levels then crosses
spinocerebellar tract
ascending; unconscious proprioception, some contra and ipsilateral
dorsal columns tract
ascending; cross at medulla, kinesthesia, vibration, 2 pt discrimination, stereognosis
SCI mechanism of injury
usually indirect trauma–> violent mvt of head or trunk
magnitude/direction determines pattern and severity of injury
extent and location of bony and ligamentous damage determines spine’s stability
Single or limited # vertebra
SCIWORA
SCI without radiographic abnormality; force with pre-existing abnormality
Cervical cord innervations
C3-5= diaphragm, chief ms of inspiration via phrenic nerve C4-7= SH and arm ms C6-8= FA ext and flexors C8-T1= hand ms
Cervical injuries
most vulnerable; usually damage to lower levels of cervical
Thoracic cord
spinal roots form intercostal nerves along inferior rib margin; main ms of expiration; innervate heart and abdominal organs
Thoracic injuries
most stable, more likely to be complete, T12-L1 junction most common site
Lumbosacral cord innervations
L1-2= sympathetic pelvic and abdominal organs
L2-3= hip flexion
L3-4= knee ext
L4-5= ankle DF and hip ext
L5-S1= knee flex
S1-2= ankle PF
Sacral also innervate parasympathetic pelvic and abdominal organs
Lumbar injuries
usually inomplete
cauda equina less sensitive to trauma than spinal cord
Associated injuries
fx, pneumothorax, hemothorax, head injury, brachial plexus, peripheral nerve injury
Pathological changes
damage spreads out, rostrally and caudally
primary damage= neuronal damage
secondary damge= ischemia, inflammation, disruption of ion concentration, apoptosis
spinal shock
transient; absent or depressed caudal to lesion: motor/sensory, reflexes, autonomic function
return to function
return if brain and spinal cord remain connected; if no return, will still have reflexes at each individual level
mechanism of return
remyelination of surviving neurons
resolution of secondary problems: edema, hemorrhage, vasoconstriction
predictors of motor return
incomplete vs complete, preserved motor or pin prick sensation, early vs late return, age
neurological level
most caudal spinal cord section with intact sensory and motor function bilaterally; if motor/sensory different, can still document but should document both separately too
motor level
most caudal or lowest level with normal function bilaterally (>3/5) and level above must be 5/5
sensory level
most caudal section spinal cord with normal sensory bilaterally
complete vs incomplete SCI
complete means no motor or sensory at S4 or S5
zone of partial preservation
sensory and/or motor below neuro level, but nothing at S4 or S5; must be complete injury or ASIA A
ASIA Impairment scale A
complete; no motor or sensory function is preserved in sacral segments S4 or S5
ASIA Impairment scale B
incomplete; sensory but not motor function is preserved below neuro level and includes sacral segments S4 or S5
ASIA Impairment scale C
incomplete; motor function is preserved below neuro level and more than half key muscles below neuro level have muscle grade <3/5
ASIA Impairment scale D
incomplete; motor function is preserved below neuro level and at least half key muscles below neuro level have muscle grade of 3 or more
ASIA Impairment scale E
normal: motor and sensory function are normal; had SCI and improved to this point
UE Key muscles for ASIA
C5 elbow flexion C6 wrist ext C7 elbow ext C8 finger flex T1 finger ABD tested in supine
LE Key muscles for ASIA
L2 hip flex L3 knee ext L4 ankle DF L5 long toe ext S1 ankle PF tested in supine
Brown Sequard Syndrome
ipsilateral loss of position sense/vibration and motor along with spasticity below LOL
contralateral loss of pain/temp below LOL
Flaccid paralysis at LOL
good prognosis
Anterior Cord Syndrome
motor: anterior horn cells B sides
LMN at LOL, UMN below
Sensory: bilateral pain/temp loss at LOL and below
preservation of dorsal column (prop/vibration)
Poor prognosis
Central cord syndrome
motor loss UE>LE
Sensory loss variable, may be sacral sparing S4-S5
ok Prognosis
Conus medullaris syndrome
vertebral level T12-L2
contains motor neuron for B&B
sacral sparing
sacral sparing
refers to incomplete lesion- have perianal sensation and external sphincter control
Cauda Equina syndrome
LMN incomplete injury
behaves like a PN injury- flaccid paralysis B&B function
full recovery not typical
