Exam 3 Neuro: Problems of the Central Nervous System: The Spinal Cord (10 questions)

Question 1

Complete spinal injury

Answer 1

Total loss of sensory and motor function below level of injury

• Tetraplegia (Quadriplegia)
• Paraplegia

Question 2

Tetraplegia (Quadriplegia)

Answer 2

• Paralysis of both arms and legs
• Injury to cervical region C1-C8
• Airway management
• Paralysis of diaphragm if injury above C3
  Requires wheelchair with breath, head,
  or shoulder control
• Varying degrees of arm and hand use

Question 3

Paraplegia

Answer 3

• Paralysis of both legs
• Injury to thoracolumbar region T2-L1
• May have full use of arms
• May require wheelchair or have some limited use lower extremities
• May have some respiratory compromise (varying degrees of intercostals and abdominal muscle paralysis

Question 4

Incomplete spinal injury

Answer 4

• Mixed loss of voluntary motor activity and sensation below level of injury

Types:

• Brown-Sequard Syndrome
• Central Cord Syndrome
• Anterior Cord Syndrome
• Posterior Cord Syndrome

Question 5

Brown–Sequard Syndrome

Answer 5

• Transection/Damage of one side of spinal cord (precise like getting stabbed by ice pick)
• Below injured site cord…
• Loss voluntary motor function
  same side as Injury
• Loss of pain, temperature, & sensation
  opposite side of injury

Question 6

Central Cord syndrome

Answer 6

• Associated with cervical flexion/extension injury
• Hematoma formation in center of cervical cord
• Motor weakness
  Upper extremities weaker than lower
  “I can dance but cannot play the piano”
• Sensory function varies
  Varying degrees bowel and bladder dysfunction

Question 7

Anterior Cord Syndrome

Answer 7

• Acute compression of anterior portion of spinal cord
• Associated with flexion injuries or acute herniation of an intervertebral disc
• Loss motor function below site of injury
• Loss pain, temperature,& crude sensation

Question 8

Posterior Cord Syndrome

Answer 8

• Associated with cervical hyperextension injury
• Damage to the posterior column
• Loss position sense, vibration, and pressure (May not have ability to walk)
• Motor function, pain and temperature sensation intact

Question 9

Spinal shock

Answer 9

• Initial period of flaccid paralysis and loss of sensation and reflexes
• Lasts between 48 hrs to several weeks

Question 10

Neurogenic Shock

Answer 10

Loss of vasomotor tone & sympathetic innervation of heart

Question 11

Neurogenic Shock symptoms

Answer 11

• Hypovolemia, vasodilation, ↓SVR, ↓Venous Return, ↓Stroke Volume, ↓CO, ↓Preload, Inhibited Baroreceptor response
• Blood vessels unable to constrict
• Low HR
• Poikilothermic (takes on temperature of the room)
• Skin warm & dry

Question 12

Spinal cord injury management goals (spasms)

Answer 12

• Prevent spasms
  Inappropriate reflexes:
  hyperreflexia
• Mild twitches, convulsion, erections
• Relieve spasms: with warm baths, muscle relaxants, antispasmodics

Question 13

Spinal cord injury management goals (contractures and decubiti)

Answer 13

• Prevent contractures and decubiti
  Turn Q2h
  OOB to Chair ASAP
  Specialty beds that provide side-to-side lateral rotation
• DVT prevention
  anitcoagulants

Question 14

Spinal cord injury complications

Answer 14

• Autonomic Dysreflexia/Hyperflexia (can occur throughout the patient’s life)
• Exaggerated autonomic response to stimuli resulting in profound hypertension
• Occurs mostly in tetraplegics
• Caused by:
  Distended bladder or rectum
  Stimulation of skin, pain

Question 15

Autonomic Dysreflexia/Hyperflexia

Answer 15

• Severe HTN (SBP may be 300)
• Bradycardia
• Severe HABlurred vision
• Nausea, Restlessness
• Skin Flushed above injury, Pale below
• Distended bladder, bowel

Question 16

Multiple Sclerosis risk factors

Answer 16

• Viruses or infectious agents
• Cold climate
• Physical injury
• Emotional stress
• Pregnancy
• Overexertion
• Temperature extremes
• Hot shower/bath

Question 17

Multiple Sclerosis symptoms

Answer 17

• Fatigue
• Pain or paresthesia
• Diplopia
• Tinnitus
• Dysphagia
• Muscle spasticity
• Ataxia
• Bladder dysfunction

Question 18

Multiple Sclerosis medication

Answer 18

• Immunosuppressive agents
  Azathioprine & cyclosporine
• Corticosteroids
  Prednisone
• Immunomodullators
  Interferon beta
• Anticonvulsants
  Carbamazepine
• Antispasmodics
  Dantrolene, baclofen

Question 19

ALS pathophysiology

Answer 19

- Progressive motor neuron disease
Upper & lower motor neurons
-  Destruction of motor neurons
Brain
- Anterior gray horns of the spinal cord
- Sensory pathways not effected
- Etiology unknown

Question 20

ALS symptoms

Answer 20

• Muscle weakness, wasting, atrophy
• Muscle spasticity & hyperreflexia
• Fasciculations (tremoring of the muscle)
• Brain stem signs
  Dysarthria, dysphagia
• Dyspnea, respiratory paralysis
• Fatigue

Question 21

ALS care during progression

Answer 21

• Physical therapy, Speech therapy, Occupational therapy
• Nutrition
  Enteral feedings
• Monitor for progression
  Airway
  Trach, home vents
• Counseling, support groups
• End of life discussions

Question 22

Spinal cord injury emergency management

Answer 22

• maintain patent airway
• If unresponsive insert oral airway, keeping neck in neutral position
• Jaw thrust method to open airway
• Provide oxygen/ventilator
• IF injury above C3 need mechanical ventilation
• 1Monitor ABG’s, suction prn