Pathology of NS

Question 1

SCI Categorized

Answer 1

Traumatic
Most common cause of adult SCI

Nontraumatic injuries

Question 2

Paraplegia

Answer 2

Impairment or loss of motor and/or sensory function in the thoracic, lumbar, or sacral segments of the spinal cord

Paralysis and loss of sensation in the legs

Question 3

T6 paraplegia

Answer 3

paralysis below the chest

Question 4

L1 Paraplegia

Answer 4

paralysis below the waist

Question 5

Tetraplegia (quadriplegia):

Answer 5

Impairment or loss of motor and/or sensory function in the cervical segments of the spinal cord

Question 6

Cervical SCI

Answer 6

paralysis of all 4 extremities

Question 7

Causes of SCI

Answer 7

Vehicular
Falls
Violence
Sports
Medical/other

Question 8

SCI Result of

Answer 8

Vertebral injuries
Due to acceleration, deceleration or deformation forces

Violent displacement, stretching, compression, shearing or penetration

Question 9

The sensory examination consists of testing dermatomes on each side of the body using pinprick and light touch, which are then scored as

Answer 9

0 = absent
1 = impaired
2 = normal

Question 10

Function of the external anal sphincter is recorded as

Answer 10

yes or no

Question 11

Complete lesion

Answer 11

No sensory or motor function can be demonstrated below the level of the lesion

Question 12

Incomplete Lesion

Answer 12

Partial loss of sensory and motor function below the level of the injury

Question 13

AISA Impairment Scale
A

Answer 13

Complete
no motor, sensory, sacral sparing

Question 14

AISA Impairment Scale
B

Answer 14

Incomplete
no motor, sensory only

Question 15

AISA Impairment Scale
C

Answer 15

Incomplete
50% of muscles LESS than grade 3

Question 16

AISA Impairment Scale
D

Answer 16

Incomplete
50% of muscles MORE than grade 3

Question 17

AISA Impairment Scale
E

Answer 17

Normal
motor and sensory are normal

Question 18

Spinal shock

Answer 18

cessation of spinal cord function below the lesion

BP may fall significantly

All skeletal muscle reflexes are nonfunctional (may take 2 weeks to several months)

Sacral autonomic reflexes that regulate bladder and bowel function may be suppressed for several weeks

The mechanism is poorly understood

Question 19

Blood flow changes
Ischemia and necrosis occur primarily in

Answer 19

gray matter

Question 20

Blood flow changes
Macrophages enter the lesion and begin to

Answer 20

digest the necrotic debris

Question 21

Blood flow changes
Axonal swelling and increased

Answer 21

permeability of blood vessels

Question 22

SCI Diagnosis

Answer 22

Lateral film studies with plain radiographs
CT scans & myelography
Magnetic resonance imaging (MRI)
Neurophysiologic studies

Question 23

HEMICORD lesion common causes

Answer 23

gun shot
stab wound

Question 24

Hemicord lesion

Answer 24

Lateral CST = ipsilateral UMN- type weakness
PCML = ipsilateral vibration and joint position loss
ALS = contralateral pain and temperature loss of body below the level of lesion; at the lesion level could be bilateral loss

Question 25

Central Cord Syndrome (small lesion)

Answer 25

ALS (crossing at the ventral commissure) = bilateral loss of pain and temperature (body) Lesions at cervical cord (cape distribution)

Question 26

Central cord syndome caused by

Answer 26

hyperextension injuries in the cervical region

Question 27

Posterior cord syndrome

Answer 27

PCML: loss of vibration and position sense bilaterally

Question 28

Posterior cord syndrome preservation of

Answer 28

motor function, pain

Question 29

Posterior cord syndrome Larger lesion can affect

Answer 29

lateral CST: UMN – type weakness

Question 30

anterior cord syndrome

Answer 30

ALS: loss of pain & temperature below the level of the lesion Damage to anterior horn cells: LMN signs at the level of the lesion Lateral CST (can be involved): UMN signs Preservation of PCML

Question 31

Proper Emergent Care Is Critical Assessment includes understanding the mechanics of the trauma and obtaining vital signs

Answer 31

Assess breathing Use of a rigid collar and spinal board Helps to prevent movement of the spinal column Movement of the distal components of the body Oxygen and medication Transport

Question 32

High cervical injuries require

Answer 32

immediate placement on ventilation equipment and maintenance of pulmonary hygiene

Question 33

High cervical injuries

Answer 33

Innervation to the diaphragm may be impaired Therapy consists of breathing, bronchodilators, and mucolytics Prevention of pulmonary infection

Question 34

Autonomic dysreflexia can occur

Answer 34

Common in lesions above T6 Loss of autonomic regulation due to disruption of sympathetic nervous system High blood pressure, severe headache, blurred vision, bradycardia Drugs may be used to lower the blood pressure

Question 35

Spasticity can be exacerbated by

Answer 35

Sudden change in temperature Physical or emotional stress Constipation Infection Fracture or a pressure sore

Question 36

Treatment of spasticity

Answer 36

Medications Modalities, stretching, splinting, exercise, standing program

Question 37

Flaccid bladder/LMN bladder

Answer 37

Seen in patients with injury T12 below associated with lower motor neuron alterations

Question 38

Spastic bladder/UMN bladder

Answer 38

Seen in patients with injury at or above T12 and associated with UMN alterations

Question 39

Dysesthesia

Answer 39

Impairment of sensation usually perceived as pain, can occur in areas that have no sensation Described as "burning," "pins and needles," or "tingling"

Question 40

Pain due to irritation of the nerve root is common, especially in

Answer 40

cauda equina injury

Question 41

SCI Secondary Complications

Answer 41

Contractures Deep vein thrombosis Pressure sores Postural hypotension Osteoporosis below the level of the lesion Kidney stones Musculoskeletal pain can result from faulty posture