Nervous system: Spinal injuries Flashcards
What are the most common sites of spinal injury?
50% at C6/7
30% at C2
Children more likely to injury C1/2 due to heavier heads and more lax ligaments.
What C spine injuries can be caused by hyperflexion?
Fractures: anterior wedge
Dislocations: anterior subluxation, atlanto-occipital dislocation, atlanto-axial dislocation
What C spine injuries can be caused by extension injuries?
Fractures: Hangmans, teardrop
Dislocations: anterior atlanto-axial dislocation
What are the causes of complete cord transection syndrome?
Trauma Infarction Transverse myelitis Abscess Tumour
What are the clinical features of complete cord transection syndrome?
Loss of all modalities below the level of the lesion.
Loss of autonomics so can become hypotensive
Increased arterial blood flow causes priapism (prolonged sustained erection)
What are the causes of brown-sequard syndrome?
Penetrating trauma Fractured vertebrae Tumour Abscess Multiple sclerosis
What are the clinical signs of brown-sequard syndrome?
Ipsilateral - loss of motor function (corticospinal), loss of proprioception, vibration and touch (dorsal column)
Contralateral - loss of pain and temperature sensation (spinothalamic)
What are the causes of anterior cord syndrome?
A flexion injury leading to fractures/dislocations of vertebrae and herniated discs.
Injury to the anterior spinal artery - vascular or atherslcerotic disease in elderly, iatrogenic to cross clamping the aorta during surgery.
What are the clinical features of anterior cord syndrome?
Loss of motor function, pain and temp sensation below the lesion.
Dorsal column modalities are preserved eg conscious proprioception, 2 point discrimination and vibration.
Get autonomic dysfunction eg bowel, bladder and sexual dysfunction
What are some causes of central cord syndrome?
- Trauma - hyperextension of C spine elderly, hyperflexion fo C spine in younger pts.
- Disruption of blood flow
- Cervical spinal stenosis
- Degenerative spinal disease - the ligamentum flavum compresses the cord and causes contusions to central cord.
- Syringomelia
What is syringomelia?
The development of a syrinx (cyst) in the central canal.
It is rare, chronic and progression with unknown aetiology.
Symptoms begin from spinothalamic fibres decossating in the white commisure.
Get cape distribution (neck and arm fibres more medial) then progresses to legs as it grows.
Sensitivity to light touch and proprioception are preserved.
What are the causes of posterior cord syndrome?
Very rare. More likely due to chronic pathological processes: - spondylosis - spinal stenosis - infections - vit B12 deficiency
Also occlusion of the paired posterior spinal arteries.
What are the clinical features of posterior cord syndrome?
Loss of proprioception, vibration, 2 point discrimination and light touch below the level of the lesion.
Motor function, pain and temp are preserved.
What is the immediate management of spinal cord injuries?
ABCDE approach.
Assume spinal injury if there is a head injury, decreased GCS, spinal tenderness, weakness, loss of sensation.
Immediately immobilise the C spine - manually, then with a rigid C collar. Move pt using the log roll.
Why might a patient with a spinal injury have hypoxia, hypotension and/or hyperthermia?
Hypoxia: there is unopposed vagal activity so RR is slow
Hypotension: there is loss of sympathetic tone so vessels dilate. Generally don’t respond well to fluid resus because they are not hypovolaemic.
Hypothermia: vasodilated and lose the ability to shiver.
