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Neuro III > Classifications, Syndromes, and Mechanism of Injury > Flashcards

Classifications, Syndromes, and Mechanism of Injury Flashcards

1
Q

What are the non-traumatic types of injuries?

A 
Infections
Vascular lesions or inflammatory disorders 
Diseases or degeneration
Congenital anomalies
Psychological causes
Neoplasms
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2
Q

What is transverse myelitis?

A 
a common inflammatory disorder that is common in rehab facilities. 
progresses over a 48 hour to week period
50% have paralysis
All have neurogenic bladder
80-90% have sensory problems
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3
Q

What is the prognosis for transverse myelitis?

A

1/3 recover
1/3 paraplegic
1/3 some neural deficits

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4
Q

What are the traumatic causes of SPI?

A

Vehicular, Falls, Violence, Sports and other

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5
Q

What material is in the white matter of the spine?

A

Axons

Descending and ascending tracts

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6
Q

What material is in the grey matter of the spine?

A

Cell bodies

Anterior horn cells

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7
Q

What is conus medullaris?

A

The termination of the SPC (L1-L2)

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8
Q

What is the filum terminale?

A

The single part of SPC that anchors it to the coccyx

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9
Q

What is the cauda equine?

A

The rest of the nerve roots from the end of the SPC (horse’s tail)

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10
Q

What are the parts of the vertebra?

A 
Vertebral canal
Spinous process,
Transverse process
Lamina
Pedicle
Facet Joints
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11
Q

What are the ligaments in the spine?

A

Alar ligament
Tranverse ligament of the Atlas
Anterior longitudinal ligament
Posterior longitudinal ligament

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12
Q

What is the blood supply to the SPC?

A

Anterior spinal artery (1)

Posterior spinal artery (2)

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13
Q

What is the corticospinal tract?

A

Descending tract, crosses at medulla (90%), voluntary movement and innervates skeletal muscles

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14
Q

What is the vestibulospinal tract?

A

Descending tract, ispilateral, upright posture and head stability

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15
Q

What is recticulospinal tract?

A

Descending tract, starts in RAS, ventral (ipsi) facilitates extension, lateral (ipsi and contra) muscle tone

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16
Q

What is the rubrospinal tract?

A

Descending tract, starts in red nucleus, ipsilateral, facilitates UE flexion

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17
Q

What is the tectospinal tract?

A

Descending tract, facilitates reflexes, posture of head, and response to vision. Coordinates head and eye movement

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18
Q

What is the spinothalamic tract?

A

Ascending tract, lateral and anterior, facilitates pain and temperature, lateral ascends 2-4 levels before crossing

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19
Q

What is the spinocerebellar tract?

A

Ascending tract, contralateral and ipsilateral, facilitates unconscious proprioception

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20
Q

What are the dorsal columns?

A

Ascending tracts, cross at medulla, facilitate kinesthia, vibration, proprioception, tactile discrimination (2pt, stereognesis)

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21
Q

What are the descending tracts?

A 
Corticiospinal
Vestibulospinal
Recticulospinal
Rubrospinal
Tectospinal
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22
Q

What are the ascending tracts?

A

Spinothalamic
Spinocerebellar
Doral columns

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23
Q

What are the most common mechanisms of injury?

A 
FORCED FLEXION
forced extension
axial loading
shearing 
distraction
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24
Q

What does the magnitude and direction or injury determine?

A

The pattern and severity of injury.

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25
Q

What determines the spine’s stability?

A

The extent and location of bony and ligamentous damage

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26
Q

What does C3-C5 innervate?

A

Diaphragm (phrenic nerve)

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27
Q

What does C4-C7 innervate?

A

The shoulder and arm musculature

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28
Q

What does C6-C8 innervate?

A

Forearm flexors and extensors

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29
Q

What does C8-T1 innervate?

A

Hand musculature

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30
Q

Facts about cervical injuries

A 
Most vulnerable (52%)
usually lower levels d/t smaller canal
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31
Q

Facts about thoracic injuries

A

Most stable and likely to be complete

T12-L1 junction must vulnerable d/t changing from stability to flexibility

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32
Q

Facts about lumbar injuries

A

Usually incomplete

cauda equine less sensitive because not a solid structure

33
Q

What does L2-L3 mediate?

A

Hip flexion

34
Q

What does L3-L4 mediate?

A

Knee extension

35
Q

What does L4-L5 mediate?

A

Ankle dorsiflexion and hip extension

36
Q

What does L5-S1 mediate?

A

Knee flexion

37
Q

What does S1-S2 mediate?

A

Ankle plantar flexion

38
Q

What do the sacral nerve roots provide?

A

Parasympathetic innervation to pelvic and abdominal organs, (L1-L2 contain sympathetic innervation of pelvic and abdominal organs)

39
Q

What are the associated injuries of a SPI?

A 
fracture
pneumothorax
hemothorax
head injury (TBI)
brachial plexus injury
peripheral nerve injury
40
Q

How does damage spread?

A

Outward, rostrally, and caudally

41
Q

What is the primary damage of the pathological changes?

A

Neuronal damage

42
Q

What is the secondary damage of the pathological changes?

A

Ischemia
inflammation
disruption of ion concentrations (decrease excitability)
apoptosis (cell death)

43
Q

What is the effect of spinal shock?

A 
immediate response (transient)
motor/sensory function, spinal reflexes, and autonomic function is absent or depressed caudal to the lesion
will recover some function days to months afterward
44
Q

What is return of function?

A

If the brain and SPC stay connected, the body can have return of some function that was lost. It is rare to completely sever the SPC

45
Q

What if return does not occur?

A

Portion of the cord caudal to the injury could function i.e. spinal reflexes but no voluntary movement, sensation or autonomic function below LOL. Spinal reflexes are not a sign of return

46
Q

How does return of function occur?

A

Remyelination of surviving neurons by resolution of:
edema
hemorrhage
vasoconstriction

47
Q

What are the predictors of motor return?

A 
incomplete injury
preserved motor function
preserved pin prick sensation
early return
younger age
48
Q

What is a neurological level?

A

Most caudal level with both normal motor and sensory function bilaterally

49
Q

What is a motor level?

A

Most caudal level with normal motor function bilaterally, (3/5 or above and level above must be a 5/5 unless d/t p!)

50
Q

What is a sensory level?

A

Most caudal level with normal sensory function bilaterally

51
Q

How is a complete injury classified?

A

No motor or sensory function at S4-S5

52
Q

How is an incomplete injury classified?

A

Normal motor and/or sensory function at S4-S5

53
Q

What is zone of partial preservation?

A

Most caudal level with any innervation (only used with complete injury)

54
Q

What is ASIA A?

A

Complete. No sensory or motor function preserved in S4-S5

55
Q

What is ASIA B?

A

Sensory incomplete. Sensory function is preserved below neurological level and includes S4-S5. No motor function is reserved more than three levels below the motor level on either side

56
Q

What is ASIA C?

A

Motor incomplete. Motor function preserved below neurological level and more than 1/2 of the key muscles below LOL are rated <3/5. Includes S4-S5

57
Q

What is ASIA D?

A

Motor incomplete. Motor function is preserved below neurological level and at least 1/2 of the key muscles below LOL are rate 3/5 or more. Includes S4-S5

58
Q

What is ASIA E?

A

Normal. Sensation and motor function are graded as normal in all segments when compared with previous ASIA rating of patient.

59
Q

What are the guidelines for ASIA testing

A

Test key muscles, key sensory points, test in supine, sacral sparing basis for incomplete

60
Q

What is Brown-Sequard syndrome?

A

Usually resultant from GSW or stab wound
Ispilateral loss of position sense/vibration and motor function and will have spasticity all below LOL.
Contralateral loss of pain and temperature of LOL

61
Q

What is the prognosis of Brown-Sequard syndrome?

A

Good. 75% will ambulate I at discharge. 80-90% will have bowel and bladder function at discharge

62
Q

What is anterior cord syndrome?

A

2/3 of SPC is damaged. Bilateral loss of anterior horn cells, pain and temperature. LMN at LOL UMN below LOL. Relative preservation of dorsal columns.

63
Q

What is the prognosis of anterior cord syndrome?

A

Poor. 10-20% will recover some motor function

64
Q

What is central cord syndrome?

A

Most common incomplete injury. Occurs with stenosis in older patients and hyperextension. UE motor loss more than LE. Variable sensory loss. May or may not have S4-S5

65
Q

What is the prognosis of central cord syndrome?

A

Favorable. 77% ambulate and 42% have hand function

66
Q

What is conus medullaris syndrome?

A

Injury to conus medullaris (T12-L2 which contains B&B motor neurons) May have perianal sensation and external sphincter control. Usually B&B incontinent

67
Q

What is cauda equina syndrome?

A

Injury to the cauda equina. LMN incomplete injury and behaves like a peripheral nerve injury. (flaccid paralysis and B&B incontinent) usually will not recover fully.

68
Q

What is the incidence of a traumatic SPI?

A

12,000 survivors each year in USA

69
Q

What is the age at injury?

A

16-30 years usually. Average 33 (increase in age d/t increase in population age)

70
Q

What is the gender relationship to SPI?

A

80% male and 20% female

71
Q

What is the race/ethnicity relationship in SPI?

A 
Caucasian 66%
AA 27% 
Hispanic 16% 
Native American 2% 
Asian 2%
72
Q

What is the occupational status at time of injury?

A

60% employed

40% unemployed

73
Q

What is relationship status at injury?

A

little over 50% single, slightly lower than general population of likelihood of getting or staying married

74
Q

What is the difference in LOS with acute injury?

A

1974- 25 days

Now - 15 days

75
Q

What is the difference in LOS with rehab?

A

1974- 115 days

Now- 40 days

76
Q

What is the difference in paraplegia and quadraplegia/tetraplegia?

A

Paraplegia below T2

Quad/tetra at or above T2

77
Q

Where are patients discharged to?

A

private residence 89.3%
nursing home 6.6%
group home and other is remaining

78
Q

How many vertebrae are there?

A 
7 cervical
12 thoracic
5 lumbar
5 sacral
4 coccygeal
79
Q

How many spinal nerve roots are there?

A 
8 cervical
12 thoracic
5 lumbar
5 sacral
1 coccygeal

Neuro III (7 decks)

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