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Trauma > Neurological injuries: Spine > Flashcards

Neurological injuries: Spine Flashcards

1
Q

Where are spinal injuries most common?

A

Cervical spine (most mobile)

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2
Q

Why do you need to assess the rest of the spine in cervical spine fracture?

A

10% of patients will have a second non-contiguous vertebral column fracture

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3
Q

Which tracts can be tested clinically?

A

Dorsal
Corticospinal
Spinothalamic

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4
Q

What does the spinothalamic tract carry?

A

Pain and temperature

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5
Q

What does the corticospinal tract carry?

A

Voluntary motor

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6
Q

What does the dorsal tract carry?

A

Balance
Propriocepion
Vibrations
Light touch

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7
Q

Which tracts decussate at the medulla?

A

Lateral corticospinal

Dorsal

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8
Q

Effect of severed cord on b-p-v-l and voluntary motor (from lateral corticospinal)?

A

Ipsilateral loss as the dorsal and lateral corticospinal tracts decussate at the medulla

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9
Q

Effect of severed cord on pain and temperature?

A

Contralateral loss as the spinothalamic tract decussates as soon as it enters the spinal cord

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10
Q

Bicep reflex comes from which nerve roots?

A

C5/6

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11
Q

Tricep reflex comes from which nerve roots?

A

C7/8

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12
Q

Knee reflex comes from which nerve roots?

A

L3/4

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13
Q

Ankle reflex comes from which nerve roots?

A

S1/2

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14
Q

Muscle strength grading 5?

A

Normal power

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15
Q

Muscle strength grading 4?

A

Movement possible against gravity and some resistance

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16
Q

Muscle strength grading 3?

A

Movement possible against gravity

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17
Q

Muscle strength grading 2?

A

Movement when gravity excluded

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18
Q

Muscle strength grading 1?

A

Flicker of contraction

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19
Q

Muscle strength grading 0?

A

No strength

Complete paralysis

20
Q

Motor neurone disease (amyotrophic lateral sclerosis):

A

Affects both upper (corticospinal) and lower motor neurones resulting in mixed UMN and LMN signs

21
Q

Poliomyelitis:

A

Affects anterior horns resulting in lower motor neurone signs

22
Q

What causes Brown-Sequard syndrome?

A

Lesion is a hemi-section of the spinal cord

23
Q

Which tracts are affected in Brown-Sequard syndrome and what is the result?

A

Lateral corticospinal - ipsi spastic paresis below lesion
Dorsal columns - ipsi loss of b-p-v-l below lesion
Lateral spinothalamic - contra loss of pain and temp

24
Q

What causes subacute combined degeneration of the spinal cord?

A

Deficiency in vitamins B12 and E

Symptoms are bilateral

25
Q

Which tracts are affected in subacute combined degeneration of the sc and what is the result?

A

Lateral corticospinal - bilateral spastic paresis below lesion
Dorsal columns - bilateral loss of b-p-v-l below lesion
Spinocerebellar tracts - bilateral limb ataxia

26
Q

Differential between subacute combined degeneration of the spinal cord and Friedrich’s ataxia?

A

Friedrich’s ataxia has all of the same symptoms and tract damage as subacute + intention tremor

27
Q

Which tracts are affected in anterior spinal artery occlusion and what is the result? (anterior cord syndrome)

A

Lateral corticospinal - bilateral spastic paresis below lesion
Lateral spinothalamic - bilateral loss of pain and temp

28
Q

Which tracts are affected in syringomyelia and what is the result?

A

Ventral horns - flaccid paresis (intrinsic hand muscles)

Lateral spinothalamic - loss of pain and temperature

29
Q

Which tracts are affected in MS and what is the result?

A

Asymmetrical varying mixture of tracks resulting in combination of motor, sensory and ataxia symptoms

30
Q

Effect of central cord syndrome?

A

Upper limb weakness (motor fibres to upper limbs are more centrally located than to lower limbs)

31
Q

What causes anterior cord syndrome?

A

Thrombus in anterior spinal artery that supplies the anterior 2/3 of the spinal cord

32
Q

What is neurogenic shock?

A

Damage to the sympathetic chain and loss of vasomotor tone causing hypotension, bradycardia, hot flushing and priapism (painful and persistent erection of the penis)
Can be fatal

33
Q

Features of spinal shock:

A

Reversible loss of reflexes below level of the spinal cord injury
Occurs immediately after the injury but only lasts days to months

34
Q

Cauda equina syndrome is a…

A

Neurological emergency

35
Q

What is cauda equina syndrome?

A

Compression of the nerve roots distal to L1

36
Q

Causes of cauda equina syndrome?

A

Prolapsed disc
Bony fragments
Tumour
Abscess

37
Q

Symptoms of cauda equina syndrome?

A

Severe pain in anal sphincter, bladder and legs
Incontinence of bowel and bladder + retention
Perianal and bladder numbness
Erectile dysfunction
Leg weakness and absence of lower limb reflexes

38
Q

When is full in-line spinal immobilisation indicated?

8 things

A 
Spinal pain
Significant distracting injuries
Intoxicated
Confused/uncooperative
Reduced GCS
Hand/foot weakness or loss of sensation
Priapism
History of past spinal problems
39
Q

What are the 3 X-ray views for the cervical spine?

A

AP
Lateral
Open mouth Peg (odontoid process)

40
Q

What are the two X-ray views for thoracic-lumbar spine?

A

AP

Lateral

41
Q

What imaging should be done for suspected spinal cord injury?

A

MRI

42
Q

Which joints should be specifically examined in c. spine X-ray/CT?

A

Occipital-atlanto-axial joint

Joint between atlas and axis

43
Q

What causes Hangman’s fracture?

A

Neck hyper-extended by the weight of the whole body (i.e. hanging)

44
Q

What is a Hangman’s fracture?

A

Bilateral fracture of C2 pedicles
Prevertebral soft tissue swelling
Anterior dislocation of the C2 vertebral body

45
Q

What is a Jefferson fracture?

A

Fractures of the anterior and posterior arches of C1 when diving into shallow water

46
Q

Types of odontoid process fracture:

A 
I = Tip
II = Body
III = Base

Trauma (8 decks)

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