LECT 5 SCI Flashcards
If artery of adamkiewick is injured in renal surgery, what level of spine will be affected
T7
SCI lesion clues in history/exam
-bilateral
-sensory level
-tight sensation around torso (MS hug)
-B&B DYSFUNCTION
-Lhermitte or Uhthoff
-stiff legs
-neck/back pain
what should you do if someone might have SCI
-avoid hypotension
-immobilize head/neck
-need surgical decompression in 24 hrs
-airway protection
-plain films and CT*
cervical spondylosis is most common at
C5, C6
bc of disc, bone spurs, thick ligaments, compromised cord/roots
acute SCI is most common at
CERVICAL C5, C4
muscle grading for ASIA 0
total paralysis
muscle grading for ASIA 1
palpable/visible contraction
muscle grading for ASIA 2
gravity eliminated full ROM
muscle grading for ASIA 4
moderate resistance in full ROM against gravity
muscle grading for ASIA 5
full ROM and full resistance, can also be enough resistance to be considered normal if identified factors (pain, disuse) were not present
C6 and c8 mm groups for asia
C6: wrist extensors
C8: finger flexors
ASIA sensory eval
0-absent
1-altered
2-normal
NT-not testable
ASIA A
complete, no sensory or motor
-NO VOLUNTARY ANAL CONTRACTION
-SENSORY IS 0
DEEP ANAL PRESSURE IS 0
ASIA B
sensory incomplete
sensory preserved, but not motor
ASIA C
motor incomplete
motor preserved with more than half of mm with grade less than 3 (weak)
ASIA D
motor complete
motor preserved and stronger (half or more mm have grade 3-5)
ASIA E
NORMAL
-min A with LE dressing in bed
-mod assist with undressing LE in bed
C6 level lesion
independent with AD in bed dressing
C7
independent with AD in WC dressing
C8
min assist for upper body bathing and drying
mod A for lower body drying
AD (tub chair)
C6
set up required for communication (independent verbal, AD for written)
C6
independent bathing with AD
C7, C8
mod A for lower body drying
what should you do if someone has Autonomic dysreflexia?
-sit upright
-monitor BP every 2-3 min
-check for sources of irritation (cath if needed)
-if BP over 150, give anti HTN (ntiro paste, nifedipine IR sublingual, IV antihypertensive if in ICU
posterorlateral column syndrome
- B12 deficiency
- Copper deficiency
- Cervical spondylosis
- Paraneoplastic myelitis * HTLV1 myelopathy
CORTICOSPINAL AND DCML
subacute combined degeneration
SC syndrome from B12 or copper deficiency
-post columns and corticospinal
-sensory ataxia, gait unsteady, weakness with UMN! DTRs, spasticity
-paresthesias
in tabes dorsalis, what is clinical presentation
DCML: gait imbalance due to sensory ataxia
dorsal roots: absent reflexes but STRONG
hemicord can happen due to
trauma
MS
epidural absess
HEMICORD SYNDROME SYMPTOMS
ipsi UMN below lesion
ipsi LMN at lesion (anterior horn)
ipsi DCML loss
CONTRA ALST loss 1-2 levels below lesion
IPSI NERVE ROOT PAIN AND IPSI IMPAIRED AUTONOMIC
central cord syndrome is due to
syringomyelia
* Intramedullary Tumors
* Neuromyelitis Optica
* Cervical Hyperextension
what does syringomyelia look like
cape! weakness and atrophy of hands and arms, loss of DTRs
