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Neuromuscular management > Lecture 8 - SCI > Flashcards

Lecture 8 - SCI Flashcards

1
Q

Where does the spinothalamic tract cross

What’s it do?

A

Anterior Commisure at same level it enters spinal cord

Pain and temp

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2
Q

Where does the DCML tract cross?

What does it do?

A

In medulla

Proprioception, fine touch

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3
Q

Where does the corticospinal tract cross?

What’s it do?

A

In medulla pyramids

Motor

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4
Q

Where is the sympathetic NS located

Where is the parasympathetic NS located

A

T1 to L3

Brainstem and S2-S4

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5
Q

What is the most common cause of SCI

A

Vehicular accidents

Mainly affects males

Most common outcome: incomplete tetraplegia

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6
Q

How do you manage an emergent case of SCI

A

Immobilization of head and neck

Airway protection

Avoid hypotension

Emergent plain films and CT scan of spine

Surgical decompression (needed within first 24 hours)

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7
Q

Most traumatic injuries occur where in the spine?

A

50% cervical. Most commonly C5 followed by C4.

Thoracic next most common, then lumbar

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8
Q

A lesion around what level will cause quadriplegia vs paraplegia

A

Below cervical (C8) - paraplegia

Above cervical- quadriplegia

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9
Q

What is considered the gold standard of spinal cord injury assessment

A

ASIA international standards for neurological classification of spinal cord injury ISNCSCI

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10
Q

What does someone’s “motor level” and “sensory level” mean in a SCI

A

The lowest level still intact

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11
Q

Muscle groups in ASIA:

C5

C6

C7

A

Elbow flexor

Wrist extensor

Elbow extensor

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12
Q

Muscle groups in ASIA:

C8
T1
L2

A

Finger flexors
Small finger abductors
Hip flexors

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13
Q

Muscle groups in ASIA:
L3
L4
L5
S1

A

Knee extensors
Ankle dorsiflexors
Long toe extensor
Ankle plantarflexors

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14
Q

How is sensory graded in ASIA?

A

0- absent
1 altered/ impaired/ hypersensitive
2 - normal
NT- not testable

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15
Q

What does A mean on the ASIA impairment scale?

A

Complete (cord injury): no sensory or motor preserved in s4 s5

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16
Q

What does B mean in the ASIA scale?

A

Sensory incomplete

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17
Q

What does C mean in the ASIA scale?

A

Motor incomplete (more than half)
<3 on MMT

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18
Q

What does D mean in the ASIA scale?

A

Motor incomplete: less than half (less than half of function is gone)
>3 on MMT

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19
Q

What does E mean on the ASIA scale

A

Normal

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20
Q

What is spinal shock?

A

Immediate flaccidity and loss of sensory and automatic function below the level of a lesion

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21
Q

What does spinal shock present like?

How long does it last

A

Atonic bladder with overflow incontinence

Atonic bowel with gastric dilation

Loss of vasomotor control

Lasts days to several weeks

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22
Q

After spinal shock, what normally happens in a SCI?

A

Increased reflexes and spasticity below the level of the lesion

pathological pyramidal reflexes(Babinski and hoffman)

Spastic bladder

Paralyzed legs w/ flexion contracture

autonomic dysreflexia (depending on level)

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23
Q

SCI above what level causes babinski reflex? Hoffman?

A

Babinski - S1

Hoffman - C7

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24
Q

Autonomic Dysreflexia happens with spinal cord injuries above _____

A

T5

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25
Q

Disabilities associated w/ C1-C5 tetraplegia:

at what level do you have independent verbal communication?

A
  • Bathing and dressing: dependent
  • communication: independent w/ assistive device C1-C3

Independent verbal communication C4-C5

Assistive device necessary for keyboarding, writing, page turning, use of telephone

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26
Q

Disabilities associated w/ level of C6-C8 tetreplegia

At which level of injury can they use a wheelchair?

How is dressing?

A
  • Dressing: independent with AD in bed (C7) or wheelchair C8
  • Minimal assistance dressing
  • moderate assistance undressing
  • those w/ C8 injury can dress and undress in wheelchair
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27
Q

Disabilities associated w/ level of C6-C8 tetreplegia

How is Bathing? Upper body? Lower body?

A
  • Minimal assistance for upper body bathing and drying
  • Moderate assistance for lower body drying
  • C7 and C8 are independent w/ use of assistive devices
  • AD include tub chair
28
Q

Disabilities associated w/ level of C6-C8 tetreplegia

How is communication?

A
  • Independent verbal communication
  • AD necessary for keyboarding, writing, use of phone
  • C6 may require set up
29
Q

Disabilities associated w/ T1 injury

How is Dressing, bathing and communication

A

Dressing: independent w/ assistive device

Bathing - Independent w/ use of assistive device

communication - independent

(arms are fine)

30
Q

What are symptoms of autonomic dysreflexia

A

Hypertension (up to 300mmHg systolic)
sweating (above the injury)
Flushing (above the injury)
Bradycardia (vagus nerve is still working

note: usually due to complete transverse cord lesion, risk increases after recovery from spinal shock when transfering to rehab

31
Q

Autonomic dysreflexia triggers:

A

Full Bladder
Full or impacted bowel
Scrotal compession
kidney stones
gastritis
onset of menses
DVT
Pulmonary Embolism
Pressure ulcers
change in temp
pain or irritation below level of lesion

basically they cannot feel these things to address them

32
Q

Autonomic dysreflexia is a sudden increase in BP by _____________ resulting from harmful, painful, or injurous stimulus below the level of a spinal cord lesion

How should you position a patient whos having autonomic dysreflexia?

A

20-40mmHG

Sit patient upright (90 degrees) Monitor BP every 2-3 minutes

33
Q

What are cardiovascular complications of a SCI?

A

Arrhythmias, fluctuating BP, orthostatic hypotension

thrombophlebitis, pulmonary embolisms, edema (this is why these patients need compression, exercise, and early mobility)

34
Q

What are respiratory complications of a SCI?

A

impaired cough and reduced ability to mobilized secretions (making them more suseptible to pneumonia)

increased risk of obstructive sleep apnea

reduced exercise tolerance

35
Q

What are nutritional complications of a SCI?

A

high catabolic state

prone to poor wound healing and infection

associated paralytic ileus which may prevent oral feeding

gastritis and stress ulcers (prevented with medications)

36
Q

What are skin complications w/ SCI?

A

Ulcers, Osteomyelitis, Sepsis

Bony Prominences

Prevent with scheduled position changes

37
Q

What are sexual complications of a SCI

A

Men: impaired libido, potency, fertility

women: impaired libido and sexual response, fertility is maintaned

38
Q

What are the leading causes of death for SCI patients

A

sepsis

pneumonia

respiratoy failure

highest death rate is in first year

39
Q

Cervical spondylosis is most common at what disc levels?

A

C5 C6

due to bulging discs, bone spurs. thickening of ligaments, compromise of cord and roots

40
Q

If nerve roots are involved we might treat w/ ______

but if theres spinal cord involvement then you ________

A

Physical therapy

Need a surgery

41
Q

What are cervical spondylotic myelopathy symptoms

A

Pain

Burning

Weakness

Numbness

Tingling

Bowel and bladder

Lhermitte phenomenon

42
Q

How does spondylotic myelopathy progress?

A

Gait impairment often happens early

Lower limb will have sensory problems if dorsal column is compressed

lateral arm weakness and loss of finger dexterity

cervical radicular dysfunction

43
Q

Where is an intramedullary spinal cord tumor?

A

Within the spinal cord

44
Q

where is an extramedullar-intradural spinal cord tumor?

A

lying on the surface of the cord

arising from roots or meninges

45
Q

where is an extradural spinal cord tumor located?

A

in the extra dural space but can compress spinal cord

46
Q

Where at the majority of spinal cord metastases located?

A

70% thoracic

20% lumbar

10% cervical

47
Q

What cancers most often spread to the spinal cord?

A

Lung, breast, prostate, kidney, thyroid, gut

symptoms: back pain, tenderness, paraparesis, incontinence

48
Q
A
49
Q

What are the symptoms of an epidural abscess?

How is it diagnosed and treated?

A

Fever, local pain, radicular pain, rapid progressive paraparesis and sensory loss

diagnosis: emergency MRI

Treatment: laminectomy, drainage, antibiotics

50
Q

What can cause Posterolateral column syndrome?

A

B12 deficiency

Copper deficiency

cervical spondylosis

paraneoplastic myelitis

HTLV1 myelopathy

51
Q

What is subacute combined degeneration?

What vitamins are deficient?

What tracts does it involve?

A

Spinal cord syndrome resulting from deficiency of vitamin B12 or copper

involved posterior columns and corticospinal tracts

52
Q

What are the symptoms of subacute combined degeneration

A

DCML and corticospinal tracts r involved

resulting in weakness
paresthesias
sensory ataxia
gait unsteadiness

53
Q

What causes B12 deficiency?

where is B12 found?

A

Impaired absorption d/t gastric bypass, anemia, or IBS

found in meat, eggs, milk, fortified foods

54
Q

What can cause posterior column syndrome?

A

Neurosyphilis (tabes dorsalis)

early cervical spondylotic myelopathy

radiation induced myelopathy

55
Q

What is syphilis(Tabes dorsalis)?

How does it present?

A

Sexually transmitted infection

causes dorsal column demyelination in chronic untreated infections
-rare today

-impaired sensory and gait imbalance/ataxia

-absent reflexes with normal strenght

56
Q

What causes hemicord syndrome?

A

Gunshot/knife

MS

Epidural abscess

57
Q

Hemicord syndrome affects the

________ corticospinal tracts

__________ DCML tracts

_____________ spinothalamic tracts

A

Ipsilateral corticospinal - UMN weakness below lesion

Ipsilateral DCML - loss of sensory and proprioception below level of lesion

Contralateral spinothalamic- loss of pain and temp 1-2 levels below the lesion

58
Q

Hemicord syndrome affects the _______ anterior horn

the _______ nerve root

and the ________ descending autonomic fibers

A

ipsilateral anterior horn - ipsilateral lower motor neuron weakness

ipsilateral nerve root- ipsilateral nerve pain

ipsilateral autonomic fibers- impaired sweating

59
Q

What can cause central cord syndrome?

A

Syringomyelia

intramedullary tumors

neuromyelitis optica (NMO)

cervical hyperextension

60
Q

What is central cord syndrome?

A

Swelling in middle of spinal cord, often from cervical myelitis

61
Q

What is syringomyelia?

A

Central cavitation in spinal cord

most commonly in cervical region

-idiopathic
-associated w/ tumor or hemorrhage
-associated w/ brain malformatin
-late complication of spinal cord trauma

62
Q

How does syringomyelia present?

A

segmental weakness and atrophy of hands and arms w/ loss of tendon reflexes

“cape distribution”

may need surgical drainage of cyst

63
Q

What is a common cause of anterior cord syndrome?

A

anterior spinal artery stroke

64
Q

What is usually preserved in anterior spinal cord syndrome?

what is normally affected?

A

Pain and temp preserved, DCML preserved

mainly motor loss

65
Q

What are the symptoms of conus medullaris/ cauda equina syndromes?

______

_______ UE strength and sensation

______ reflexes in legs

sensory loss in ___________

___________ leg weakness

impaired ________________ function

A

Pain unilateral/bilateral radicular

preserved UE strength and sensation

absent reflexes in legs

sensory loss in proximal legs/ saddle anesthesia

proximal lower leg weakness

impaired B&B function

66
Q

What can cause conus medullaris/cauda equina syndromes?

A

Disc herniation

Vascular

infections

radiation

neoplastic disorders

inflammatory disorders

Neuromuscular management (19 decks)

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