Lecture 4: Spinal Cord Injury Flashcards
At what level does the spinal cord end?
L1-L2
What what spinal level os Conus Medullaris present?
~T12
What what spinal level is Cauda Equina present?
L3
What is the significance of knowing where Cauda Equina is?
This represents the change from UMN to LMN
the dorsal end of the spinal cord is known as?
Cauda Equina
What regions represent the UMN?
- Motor Cortex
- Internal Capsule
- Brainstem
- Spinal Cord
What regions represent the LMN?
- Interneurons
- Anterior Horn Cell
- Peripheral Nerve
- Motor End Plate
What is the most important motor tract in the UMN?
Lateral Corticospinal tract
Where can the sensations of pain, temperature, and itch be found in the spinal cord?
Anterolateral system
Where can the perception of proprioception be found in the spinal cord?
In the Gracile and Cunate Fasciles
The anterior horn cells are part of what system?
A. UMN
B. LMN
C. Both
B. LMN
List the different types of Spinal cord Syndromes (8)
- Lateral Cord (Brown-Sequard)
- Compete Cord
- Central Cord
- Anterior Cord
- Posterior Cord
- Pure Motor
- Conus
- Cauda Equina
The spinal thalami tract can be found where in the Spinal Cord?
Anterior lateral aspect
The Corticospinal tract can be found where in the spinal cord?
Posterior lateral aspect
Loss of motor and sensation of the legs bilaterally will be classified as what?
Complete spinal cord lesion
If the contralateral side experiences loss of pain, temperature and itch, and the Ipsilateral side experiences loss of proprioception, what is true in this case?
DCML on the ipsilateral side will be impaired
ALS on the contralateral side will be impaired
Where is the lateral corticospinal tract in the spinal cord?
Posterior lateral aspect of the spinal cord
Where are the anterior horn cells located in the spinal cord?
Anterior lateral aspect
What are of the spinal cord is responsible for vibration and position sense?
Posterior columns: Gracile and cunate fasciculus
What are the most common cases of spinal cord injuries?
MVA
Falls
Violence
Who is affected more by spinal cord injuries, males or females?
Males 4:1 Females
What are the 4 different mechanisms of injury for a spinal cord injury?
- Impact w/persistent compression (burst fracture)
- Impact w/transient compression post hyper/injury
- Distraction: Forcible stretching of spinal cord or blood supply
- Laceration from miss LE injury, sharp bone fragment dislocation, or severe distraction
When it comes to spinal cord injuries, what are the two types of injures classified as?
- Primary Injury
2. Secondary Injury
With a primary spinal cord injury, what is the cause?
- Fracture
- Vascular disruption
- Axonal shearing/disruption
With secondary spinal cord injury, what is the course?
- Spine Trauma
- Inflammatory activation of microglia and astrocytes
- Chemoattraction of Neutrophils, macrophages, lymphocytes
- Release of Cytokines/Chemokines, RNS, ROS, Complete components, Proteases
With primary and secondary spinal cord injuries, they both lead to …
=>Blood-Spinal cord barrier break-down
===>Spinal edema
When someone experiences a spinal cord injury, what is the most critical component to consider during the acute stage?
Microenvironment is critical to prevent secondary injury
Inflammation at the lesion site in the spinal cord is well-known, however less is known about what?
What level the inflammation is occurring
When a spinal cord injury, inflammation could occur up to how many segments away?
10 segments
What is the most important aspect to reduce the effects of secondary spinal cord injury?
Reduce inflammation
Inflammation in the spinal cord post injury can produce what? Specifically in the L/S region? (2)
- Maladaptive Neuroplasticity
2. No Motor Learning
Signs of UMN and LMN Lesions with respect to Spinal cord injury. Determine if UMN, LMN, or both are affected and how
Weakness
Atrophy
Fasciculations
Reflexes
Tone
Weakness: UMN & LMN
Atrophy: LMN
-UMN lesion may lead to atrophy from lack of muscle use
Fasciculations: LMN
Reflexes: Increased w/UMN; Decreased w/LMN
-w/acute UMN lesions, reflexes may be decreased
Tone: Increased with UMN; Decreased w/LMN
-w/acute UMN lesions, tone may be decreased
Describe the disease course of a Spinal cord injury
- Acute Onset
2. Progressive to stable
Describe the timeline for a Spinal Cord Injury
- Initial Traumatic Event
- Spinal Shock/Flaccid Paralysis, Loss of sensation, Loss of motor function
- Emergency response: Immobilization/Stabilization. Diagnose via MRI
- Stable: Possible UMN signs, Spasticity, Hyperreflexia
- Neurological return: Most recovery in 1 year. Most rapid recovery 1st 6 months, then slower pace up to 2 years.
What are the key diagnostic studies for determining a spinal cord injury?
(6)
- MRI (Gold Standard)
- X-Rays
- CT
- Somatosensory-Envoked Potentials
- EMG
- NCV
Describe the standard medical care for a patient that presents with a SCI
- Immobilization: Halo TLSO (Avoid Prolonged Immobilization)
- Early Inervention: Closed Reduction, Spinal Decompression
- Corticosteroids: Early Methylprednisolone IV Bolus
- BP Management
- General Care
- Nutritional Support
This drug, if given within 8 hours of injury, has been shown to have a significant effect on improvement with motor and sensation function within the first 6 months of therapy.
Corticosteroids: Early Methylprednisolone IV Bolus
What are the experimental medical management protocols for SCI?
- Therapeutic Hypothermia
2. Human Embryonic Stem Cells
What is the mortality rate for someone with a SCI?
4-17%
What are the predisposing factors for a SCI?
- Age
- Higher levels
- Pulmonary Embolism
- Medical Co-Morbidities
- Suicide
Which SCI patients have the greatest potential for recovery?
Those who suffer from Brown-Sequard syndrome
With this SCI, the LE can recover, and bowel and bladder function is seen early
Central Cord Syndrome
What is the age cut off for faster, more successful recovery for SCI?
<50 years
What are the 7 issues in Rehab for patients who present with Spinal Cord Injuries?
- Bladder Dysfunction
- Bowel Dysfunction
- Decubitus Ulcers
- Autonomic Dysfunction
- Sexual Dysfunction
- Wheelchair Seating & Positioning
- Spasticity
UMN lesions of the spinal cord are from what regions?
C1-L1
LMN lesions of the spinal cord are from what spinal levels?
L2-S5
With respect to the bowels, UMN lesions (C1-L1) can cause…
Hyperreflexia (Spastic paralysis, reflex is intact)
With respect to the bowels, a LMN lesion (L2-S5) can produce what effect?
Areflexia (flaccid paralysis)
-No Tone in the muscles
With respect to the bladder, and UMN lesion (C1-L1) has what effect?
Spastic (Urinary bladder and sphincter are overactive)
With respect to the bladder, a LMN lesion (L2-S5) has what effect?
Areflexia (Detrusor is unable to contract)
What are the symptoms associated with an UMN lesion in the spinal cord (C1-L1) for bowel and bladder?
Bowel: Constsipation, difficulty w/evacuation & Incontinence
Bladder: Increased frequency of urination/failure to store urine
-Inability to fully empty the bladder (Excessive spasms of the bladder)
What are the symptoms associated with a LMN spinal cord lesion (L2-S5) on the bowel and bladder?
Bowel: Constipation, difficulty w/evacuation & Incontinence
Bladder: Retention/Failure to empty urine
-Possible damage to kidneys and bladder wall
Clinical management of an UMN spinal cord lesion (C1-L1) for the bowels include… (5)
- Reflex defecation
- Stool Softener
- Laxative
- Suppository
- Rectal Stim