Neurological injuries: Spine Flashcards
Where are spinal injuries most common?
Cervical spine (most mobile)
Why do you need to assess the rest of the spine in cervical spine fracture?
10% of patients will have a second non-contiguous vertebral column fracture
Which tracts can be tested clinically?
Dorsal
Corticospinal
Spinothalamic
What does the spinothalamic tract carry?
Pain and temperature
What does the corticospinal tract carry?
Voluntary motor
What does the dorsal tract carry?
Balance
Propriocepion
Vibrations
Light touch
Which tracts decussate at the medulla?
Lateral corticospinal
Dorsal
Effect of severed cord on b-p-v-l and voluntary motor (from lateral corticospinal)?
Ipsilateral loss as the dorsal and lateral corticospinal tracts decussate at the medulla
Effect of severed cord on pain and temperature?
Contralateral loss as the spinothalamic tract decussates as soon as it enters the spinal cord
Bicep reflex comes from which nerve roots?
C5/6
Tricep reflex comes from which nerve roots?
C7/8
Knee reflex comes from which nerve roots?
L3/4
Ankle reflex comes from which nerve roots?
S1/2
Muscle strength grading 5?
Normal power
Muscle strength grading 4?
Movement possible against gravity and some resistance
Muscle strength grading 3?
Movement possible against gravity
Muscle strength grading 2?
Movement when gravity excluded
Muscle strength grading 1?
Flicker of contraction
Muscle strength grading 0?
No strength
Complete paralysis
Motor neurone disease (amyotrophic lateral sclerosis):
Affects both upper (corticospinal) and lower motor neurones resulting in mixed UMN and LMN signs
Poliomyelitis:
Affects anterior horns resulting in lower motor neurone signs
What causes Brown-Sequard syndrome?
Lesion is a hemi-section of the spinal cord
Which tracts are affected in Brown-Sequard syndrome and what is the result?
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
What causes subacute combined degeneration of the spinal cord?
Deficiency in vitamins B12 and E
Symptoms are bilateral
Which tracts are affected in subacute combined degeneration of the sc and what is the result?
Lateral corticospinal - bilateral spastic paresis below lesion
Dorsal columns - bilateral loss of b-p-v-l below lesion
Spinocerebellar tracts - bilateral limb ataxia
Differential between subacute combined degeneration of the spinal cord and Friedrich’s ataxia?
Friedrich’s ataxia has all of the same symptoms and tract damage as subacute + intention tremor
Which tracts are affected in anterior spinal artery occlusion and what is the result? (anterior cord syndrome)
Lateral corticospinal - bilateral spastic paresis below lesion
Lateral spinothalamic - bilateral loss of pain and temp
Which tracts are affected in syringomyelia and what is the result?
Ventral horns - flaccid paresis (intrinsic hand muscles)
Lateral spinothalamic - loss of pain and temperature
Which tracts are affected in MS and what is the result?
Asymmetrical varying mixture of tracks resulting in combination of motor, sensory and ataxia symptoms
Effect of central cord syndrome?
Upper limb weakness (motor fibres to upper limbs are more centrally located than to lower limbs)
What causes anterior cord syndrome?
Thrombus in anterior spinal artery that supplies the anterior 2/3 of the spinal cord
What is neurogenic shock?
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
Features of spinal shock:
Reversible loss of reflexes below level of the spinal cord injury
Occurs immediately after the injury but only lasts days to months
Cauda equina syndrome is a…
Neurological emergency
What is cauda equina syndrome?
Compression of the nerve roots distal to L1
Causes of cauda equina syndrome?
Prolapsed disc
Bony fragments
Tumour
Abscess
Symptoms of cauda equina syndrome?
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
When is full in-line spinal immobilisation indicated?
8 things
Spinal pain Significant distracting injuries Intoxicated Confused/uncooperative Reduced GCS Hand/foot weakness or loss of sensation Priapism History of past spinal problems
What are the 3 X-ray views for the cervical spine?
AP
Lateral
Open mouth Peg (odontoid process)
What are the two X-ray views for thoracic-lumbar spine?
AP
Lateral
What imaging should be done for suspected spinal cord injury?
MRI
Which joints should be specifically examined in c. spine X-ray/CT?
Occipital-atlanto-axial joint
Joint between atlas and axis
What causes Hangman’s fracture?
Neck hyper-extended by the weight of the whole body (i.e. hanging)
What is a Hangman’s fracture?
Bilateral fracture of C2 pedicles
Prevertebral soft tissue swelling
Anterior dislocation of the C2 vertebral body
What is a Jefferson fracture?
Fractures of the anterior and posterior arches of C1 when diving into shallow water
Types of odontoid process fracture:
I = Tip II = Body III = Base
