Last 3 clinical correlations lectures Flashcards
How is a spinal cord injury defined?
Injury or pathology to spinal cord and nerve roots INSIDE neural canal. Does not include peripheral nerves / brachial /lumbosacral plexuses.
What is tetraplegia vs paraplegia?
Tetraplegia = quadriplegia, injury to the cervical cord
Paraplegia = injury to thoracic, lumbar, sacral, or cauda equina
What gender makes up most of spinal cord injuries?
Males. New cases are around 12,500 per year.
Why is a rectal exam part of the required spinal cord exam?
Test of S4/S5, ability to contract (voluntary anal contraction) or feel pressure (deep anal pressure) tells you whether the injury is complete or incomplete
What are two elements of the neurological exam which are considered optional?
Testing of proprioception and deep pressure.
What is used to test C5?
Elbow flexion - biceps / brachialis
What is used to test C6?
Wrist extensors - extensor carpi radialis longus / brevis
What is used to test C7?
Elbow extensors - triceps
What is used to test C8?
Finger flexors to middle finger - FDP
What is used to test T1?
Abduction of pinkie - abductor digiti minimi
What is used to test L2?
Hip flexors (iliopsoas)
What is used to test L3?
Knee extensors (quadriceps)
What is used to test L4?
Ankle dorsiflexors - tibialis anterior - deep fibular nerve (L4-S1)
What is used to test L5?
Long toe extensors (extensor hallicus longus) - deep fibular nerve (L4-S1)
What is used to test S1?
Ankle plantar flexors - gastrocnemius - tibial nerve
What do muscle grades 0 and 1 correspond to?
0 - no contraction
1 - palpable contraction but no joint movement
What do muscle grades 2 and 3 correspond to?
2 - full range of motion with gravity eliminated
3 - full range of motion against gravity but no resistance
What do muscle grades 4 and 5 correspond to?
4 - full range of motion against gravity + moderate resistance
5 - normal -> resist maximum force
What do sensory gradings 0, 1, and 2 correspond to? What is the reference?
0 - absent sensation
1 - impaired (hypo / hyper)
2 - normal
Reference = face sensation
What corresponds to a 0 on the pin-prick test?
Complete inability to differentiate between sharp and dull
How is motor level scored?
Most caudal key muscle group that is graded as 3/5 or better, with segments above graded as 5/5. If not in the key muscle group range, motor level = sensory level
How is sensory level determined?
Most caudal dermatome with normal pinprick and light touch
How is the neurological level of injury (NLI) defined?
Most rostral of the sensory and motor levels
What does skeletal level mean?
The level with the greatest vertebral damage
What is ASIA-A vs ASIA-B?
ASIA - A = complete, no preservation in S4-S5
ASIA - B = sensory incomplete - S4/S5 preserved (LT, PP, or DAP) + no motor function preserved more than 3 levels below the NLI on either side
What is ASIA-C vs ASIA-D?
ASIA-C = motor incomplete, including voluntary anal contraction OR is sensory incomlpete but has sparing of motor function more than 3 levels below NLI. Must have less than half of key muscles below NLI > or equal to 3.
ASIA-D: At least half of key muscles are > or equal to 3 below the NLI
ASIA-E: normal but had prior deficits
What is the prognosis for recovery in Brown-sequard?
Good prognosis for walking (ambulation) again, ipsilateral proximal extensors recover before distal flexors
What causes autonomic dysreflexia?
Sympathetic hyperactivity when the NLI is T6 and above. Causes SANS overload and an increase in blood pressure as a result. Also sweating, abnormal heartrate, and cyanosis below the level of the injury.
How do you relieve autonomic dysreflexia?
Remove the stimulus which is being redirected to cause SANS overload. For instance, often bladder distension will be rerouted to the ILC to cause SANS overload which cannot be cortically relieved in spinal injury. Catheterizing the patient can remove this stimulus.
What are some etiopathologic causes of spinal lesions?
- Infection
- Inflammation
- Vascular
- Deficiency disorder
- Genetic disorder
- Trauma
- Tumor / other
What is the order of neurological examination?
- Higher mental function
- Cranial nerve function
- Motor system
- Sensory system
What part of the exam is praxis tested in and what is it?
Higher mental functions - ability to do learned motor activities.
Apraxia = absence
What’s the mneumonic for remembering Horner’s syndrome?
Have you met PAM Horner?
P = ptosis
A = anhydrosis
M = miosis
How do you test muscle tone?
Try to move a muscle against its primary action
What is pronator drift?
Hold arms up and close eyes. In a positive test, arms will favor pronation with arms extended and the arm will drop (relying on proprioception). It indicates an UMN lesion
What are the superficial reflexes?
Abdominal reflexes in all 4 quadrants, cremasteric reflex, plantar reflex (Babinski)
How does myopathy vs neuropathy differ in presentation?
Myopathy - proximal weakness with no sensory loss, symptoms present early and atrophy is insignificant. Reflexes and atrophy occur only very late
Neuropathy - Distal weakness (long way down the nerve), accomplanied by sensory and reflex loss. Atrophy is quick and noticeable
How does a neural injury to the neuromuscular junction present?
Fatiguable muscles with a diurnal pattern (better in the morning), as in myasthenia gravis. No atrophy
