Patho 2: Spinal Cord Injury

Question 1

Ascending tracts

Answer 1

Spinothalamic (SC)- pain snd temperature
Dorsal columns- touch, position sense, vibration
—-> cuneatus ans gracilis (medulla)
Spinocerebellar (uncrossed) - proprioceptive information

Question 2

Descending tracts

Answer 2

Corticospinal- Lateral (medulla)- motor info for limbs
Anterior (spine)- motor info for axial muscles
Vestibular- integration of hand, neck and trunk with extremities
Reticulospinal- lateral- facilitates flexion
Medial- facilitates extension
Rubrospinal (origin) - control of fine movement
Tectospinal- control muscle in response to visual stimuli

Question 3

Two types of SCI

Answer 3

Traumatic 84%

Non- traumatic

Question 4

Causes of Non traumatic SCI

Answer 4

Degenerative disc disease and spinal canal stenosis
Spinal infarct
Tumour
Inflammation of SC
Viral infection 
Developmental/congenital abnormalities

Question 5

Vulnerable areas of SCI

Answer 5

Cervical- C5-7 (55%)
Thoracolumbar T12
Mid thoracic T4-7
Majority of traumatic cases= fracture dislocstion

Question 6

Mechanisms of SCI

Answer 6

Destruction by direct trauma
Compression by bone fragment, heamatoma or disc material
Ischemia from damage or impingement of spinal arteries

Question 7

Tetraplegia/Quadraplegia

Answer 7

Impairment of motor control/sensory function in cervical segments
Affects all 4 limbs

Question 8

Paraplegia

Answer 8

Impairment of thoracic, lumbar or sacral vertebrae

Question 9

Complete SC lesion

Answer 9

Impairment of motor function
Damage to descending pathways and upper motor neurone
Damage to anterior motor neurone and lower motor neurone
Outcome more predictable

Question 10

Incomplete SC lesion

Answer 10

Sparing of some neural activities below lesion level
55-65%
Outcome less predictable

Question 11

Types of Incomplete SCI

Answer 11

Central cord syndrome
Anterior cord
Brown sequard

Question 12

Central cord syndrome

Answer 12

UL motor syndrome
Bladder dysfunction
Corticospinal and spinothalamic tracts

Question 13

Anterior cord

Answer 13

Motor paralysis below lesion
Loss of pain snd temperature
Retained proprioception and vibration
Cause- disc herniation

Question 14

Brown sequard

Answer 14

Motor deficit and numbness to touch and vibration on same scale as lesion
Loss of pain and temperature sensation on opposite side
Cause- stab/gunshot to cervical or thoracic spine

Question 15

ASIA- myotomes and dermatomes

Answer 15

C5- shoulder abd/LR, elbow flexors
C6- wrist ext/flex, pron/sup
C7- shoulder add/MR, elbow ext
C8- finger flex/ext
T1- finger abd
L2- hip flexion
L3- knee ext
L4- ankle dorsi flex
L5- long toe ext
S1- ankle plantar flex
S4/5- anal sphincter

Question 16

Cauda equina syndrome

Answer 16

affecting the base of the spine affecting the peripheral nerves rather than the spinal cord as the cord changes into the peripheral nerves at L1 leading to pain, sensory and motor deficit.