HNN PBL2 Flashcards

1
Q

What is spinal shock?

A

the loss of all neurological activity below the level of injury

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2
Q

What does the loss of neurological activity from spinal shock include?

A

motor, sensory, reflex and autonomic function

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3
Q

What are the clinical features of spinal shock?

A
  • Loss of pain (nociception)
  • Loss of proprioception
  • Sympathetic dysfunction (bowel & bladder)
  • Loss of thermoregulation
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4
Q

What are the 4 phases of spinal shock?

A
  • Areflexia
  • Initial reflex return
  • hyperreflexia
  • hyperreflexia- spacicity
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5
Q

What is the usual timescale for Phase 1 of spinal shock?

A

0-1d

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6
Q

What is the usual timescale for Phase 2 of spinal shock?

A

1-3d

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7
Q

What is the usual timescale for Phase 3 of spinal shock?

A

1-4w

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8
Q

What is the usual timescale for Phase 4 of spinal shock?

A

1-12m

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9
Q

What is the underlying physiology of Phase 1 of spinal shock?

A

Loss of descending facilitation - Neurones involved in various reflex arcs lose the basal level of excitatory stimulation they normally receive from the brain

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10
Q

What is the underlying physiology of Phase 2 of spinal shock?

A

Denervation super sensitivity - reflexes return due to the hypersensitivity of reflex muscles following denervation → more receptors for neurotransmitters are expressed and muscles therefore are easier to stimulate

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11
Q

What is the underlying physiology of Phase 3 of spinal shock?

A

Axon-supported synapse growth - Interneurones and lower motor neurons below the transection begin sprouting, attempting to reestablish synapses

first synapses to form are from shorter axons (usually from interneurones)

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12
Q

What is the underlying physiology of Phase 4 of spinal shock?

A

soma-supported synapse growth - Interneurones and lower motor neurons below the transection begin sprouting, attempting to reestablish synapses

takes longer since synapse formation is soma-mediated (takes longer for axonal transport to push growth factors and proteins from soma to the end of the axon)

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13
Q

Why do reflexes return a bit?

A

due to the hypersensitivity of reflex muscles following denervation → more receptors for neurotransmitters are expressed and muscles therefore are easier to stimulate

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14
Q

How can spinal shock be tested for?

A

Checking the bulbocavernosus reflex

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15
Q

What is the first reflex to return after spinal shock subsides?

A

Babinski (or plantar) reflex

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16
Q

What can spinal cord injury result from?

A

Trauma or compression

17
Q

In somatic motor pathways where is the upper motor neurone?

A

Cell body lies in the primary motor cortex

18
Q

In somatic motor pathways where is the lower motor neurone?

A

cell body lies in the nucleus of brain stem/ spinal cord

19
Q

how do the upper and lower motor neurones interact?

A

The upper motor neurone synapses with the lower motor neurone, which in turn innervates a single motor unit in a skeletal muscle. Activity in the upper motor neurone may facilitate or inhibit the lower motor neurone.

20
Q

What spinal nerves innervate the diaphragm?

A

C3,4 and 5

21
Q

What nerves innervate the intercostal muscles?

A

C6 and 7

22
Q

what does it mean if there is a lesion below C4 but above C6/7?

A

Breathing will occur but without the assistance of the respiratory/ accessory muscles

23
Q

Do lesions below C6/7 affect breathing?

A

No

24
Q

What does a lesion at C1-4 cause?

A

Quadriplegia (paralysis of all 4 limbs)

25
Q

What does a lesion at C5 cause?

A

Control of the shoulder and biceps but no wrist/hand control

26
Q

What does a lesion at C6 cause?

A

Wrist control but no hand control

27
Q

What does a lesion at C7/T1 cause?

A

Most upper limb control, however fine dexterous control of hands/fingers affected

28
Q

What does a lesion at T1-8 cause?

A

Paraplegia (both lower limbs), poor control of trunk/abdominal muscles.

29
Q

What does a lesion in the Lumbar/sacral region cause?

A

Decreased control of hip flexors and legs

30
Q

At what point of the spinal cord will a lesion cause issues with bladder control/

A

A spinal cord injury at almost every part of the cord will result in the loss of bladder control

31
Q

Where is the micturition centre?

A

S2-4

32
Q

If there is a lesion at S4/5 will there be bladder control?

A

There will be some control left

33
Q

What type of motor neurone lesion causes muscle wasting?

A

Lower motor lesion

34
Q

What type of motor neurone lesion causes vasiculations?

A

Lower motor lesion

35
Q

What type of motor neurone lesion causes flaccid muscle tone?

A

Lower motor lesion

36
Q

What type of motor neurone lesion causes spastic muscle tone?

A

Upper motor lesion

37
Q

What type of motor neurone lesion causes reduced or absent tendon jerk reflexes?

A

Lower motor lesions

38
Q

What type of motor neurone lesion causes exaggerated tendon jerk reflexes?

A

Upper motor lesion