Lecture 9: Concussion and Spinal Cord Disorders

Question 1

Concussion definition

Answer 1

disturbance in brain fxn caused by direct or indirect force to the head

Question 2

Concussion presentation

Answer 2

fxnl rather than structural injury that can affect somatic, cognitive and affective domains; sleep disturbances also common

Question 3

Concussion Sx’s

Answer 3

• Headache is most common
• others = dizziness, balance disturbances, disorientation, LOC, suppressed reflexes, fall in BP, transient arrest in reap, convulsive activity, retrograde amnesia

Question 4

Dx of concussion

Answer 4

• must have temporal rltnshp btwn an appropriate mechanism of injury and onset or worsening of sx

Question 5

Mechanism of Concussion

Answer 5

• rotational and angular forces to the brain
• shear forces disrupt neural membranes allowing K+ efflux into extracellular space
• have further influx of Ca and AAs which suppress neuron activity
• asa Na/K pumps restore balance, more E needed there so decrease cerebral blood flow

Question 6

Initial Eval of Concussions

Answer 6

• begin at cervical spine/site of injury

- monitor for deterioration of sx’s over several hours

Question 7

Hospital Eval/Imaging of Concussions : indications

Answer 7

• pts with LOC or amnesia + one of following: HA, vomiting, age > 60, intoxication, deficits in short term memory, evidence of trauma above clavicle, seizures, GCS < 15, neuro deficits, coagulopathu
• pts with NO LOC or amnesia + one of following: focal neuro deficit, vomiting, HA, age > 65, signs of basilar skull fx, GCS < 15, coagulopathy

Question 8

Type of imaging

Answer 8

CT = initial choice

MRI

Question 9

Management

Answer 9

• cognitive rest
• physical rest
• meds/intervention

Question 10

Spinal cord injury: pathophysiology

Answer 10

• most result from some combo of flexion, flexion-rotation, extension or vertical compression injury to neck or back
• can occur from blunt trauma, perforating wounds, vertebral dislocation or fragments of vert. fx’s
• secondary hemorrhage/edema can lead to spinal cord ischemia

Question 11

Clinical presentation

Answer 11

• urinary retention/constipation/ilues
• hypotension, bradycardia
• hemiplegia, hemiparesis (sparing face)
• paraplegia, paraparesis
• quadriplegia, quadriparesis
• loss of sensation –> unilateral or bilateral

Question 12

Imaging for spinal cord injuries

Answer 12

• AP and lateral plain Xray of cervical, thoracic and lumbar spine
• CT: preferred for defining vert. injuries, can show evidence of edema or hemorrhage

Question 13

Complete transection of spinal cord

Answer 13

• disrupts all ascending and descending neural pathways within cord
• causes total loss of all motor fxns and sensation below injury
• 99% with this injury will have NO recovery

Question 14

High cervical complete transection

Answer 14

-quadriplegia, anesthesia in trunk and all extremities, and resp. failure

Question 15

Thoracic or Lumbar injuries

Answer 15

-paraplegia, loss of sensation in LE

Question 16

Determination of level of complete transection injury

Answer 16

-determine dermatomal level which sensation is lost

Question 17

Incomplete spinal cord lesion

Answer 17

• usually due to edema or hemorrhage within cord causing sensory/motor interruption
• regain fxn over weeks to mnths
• will have intact sensation in perianal, anal sphincter tone or slight flexor toe mvmnt

Question 18

Anterior cord syndrome: causes and features

Answer 18

• results from injury to ventral spinal cord
• bilateral paresis and paralysis and decrease pain and temp distal to lesion
• intact vibration, proprioception and crude touch (post column spared)

Question 19

Anterior spinal cord causes

Answer 19

• cervical flexion injuries causing cord contusion

- laceration of ant. spinal cord by fragments from vert. fx’s

Question 20

Central spinal cord syndrome: causes and features

Answer 20

• due to hyperextension of neck
• decreased pain/temp, and muscle weakness in UE bilaterally
• legs affected to a lesser degree

Question 21

Brown-Sequard syndrome

Answer 21

• mostly due to GSW or stab wound that injures 1/2 of spinal cord
• loss of motor fxn and proprioception/vibration ipsilateral to side of lesion
• loss of pain/temp contralateral to side of lesion
• bowel/bladder conserved

Question 22

Cauda-Equina syndrome

Answer 22

• severe injuries below L2 level of spine: injures lumbar, sacral and coccygeal nerve roots
• decrease sensation over buttocks, perieneal, bilateral leg pain/weakness, bowel/bladder dysfxn, decreased rectal sphincter tone