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ESA 5 - Nervous System > Pathophysiology and Management of Spinal Cord Injuries > Flashcards

Pathophysiology and Management of Spinal Cord Injuries Flashcards

1
Q

What sensory modalities are carried in the dorsal columns?

A
  • Vibration and conscious proprioception
  • Two point-discrimination
  • Light touch
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2
Q

What modalities are carried in the corticospinal tract?

A

Motor

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3
Q

What sensory modalities are carried in the spinothalamalic tracts?

A
  • Pain
  • Temperature
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4
Q

What is the most common cause of spinal injury?

A

Physical trauma, e.g. cars, contact sports, assault, falls, alcohol

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5
Q

How much more likely are males to have spinal cord trauma than womens?

A

4x

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6
Q

What % of those with a head injury have concurrent C-spine injuries?

A

10-20% have C-spine injures, and approx 30% of these have other spinal injuries

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7
Q

What % of patients with a head injury have a neurological deficit?

A

30%

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8
Q

What are the most common sites for spinal injuries?

A
  • 50% in C6 and C7
  • 30% in C2
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9
Q

Where are children more likely to obtain spinal injuries?

A

C1-C2

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10
Q

Why are children more likely to injure C1-C2?

A

They have heavier heads with lax ligaments

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11
Q

What forces are involved in spinal injuries?

A
  • Hyperflexion
  • Hyperextension
  • Lateral stress
  • Rotation
  • Compression
  • Distraction
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12
Q

What is hyperflexion?

A

Forward movement of the head

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13
Q

What is hyperextension?

A

Backward movement of the head

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14
Q

What is lateral stress?

A

Sideways movement of the head

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15
Q

What is rotation?

A

Twisting of the head

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16
Q

What is compression?

A

Force along the axis of the spine downward from the head or upward from the pelvis

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17
Q

What is distraction?

A

Pulling apart of the vertebrae

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18
Q

What are the potential injuries that can result flexion?

A
  • Fractures
  • Dislocation
  • Often lead neurological injury

​

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19
Q

What fractures can be caused flexion injuries?

A
  • Anterior wedge
  • Flexion teardrop
  • Clay-shoveller’s
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20
Q

What dislocations can be caused by flexion injuries?

A
  • Anterior sublaxation
  • Bilateral interfacet dislocation
  • Antlanto-occipital dislocation
  • Anterior atlanto-axial dislocation
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21
Q

What fractures can be caused by extension injuries?

A

Hangman’s teardrop

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22
Q

What dislocation can be caused by extension injuries?

A

Anterior atlanto-axial dislocation

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23
Q

What happens in complete cord transection syndrome?

A

The entire cord is gone

24
Q

What are the causes of complete cord transection syndrome?

A
  • Trauma
  • Infarction
  • Transverse myelitis
  • Abscess
  • Tumour
25
Q

What are the clinical features of complete cord transection syndrome?

A
  • Spinal shock and autonomic dysfunction with higher lesions
  • Priapism
  • Complete loss of sensation below the lesion
  • Complete paralysis below the lesion
26
Q

What happens in Brown-Sequard Syndrome?

A

Get complete hemisection of cord - one side lost

27
Q

How common is Brown-Sequard syndrome?

A

Rare

28
Q

What can cause Brown-Sequard Syndrome?

A
  • Penetrating trauma
  • Fractured vertebrae
  • Tumour
  • Abscess
  • Multiple sclerosis
29
Q

What are the clinical features of Brown-Sequard Syndrome?

A
  • Loss of motor function on side of injury
  • Loss of conscious proprioception, vibration, and touch sensation on the side of injury
  • Loss of pain and temperature sensation on the contralateral side of injury
30
Q

What can cause anterior cord syndromes?

A
  • Flexion injury, leading to fractures or dislocations of vertebrae or herniated discs
  • Injury to the anterior spinal artery
31
Q

What can cause anterior spinal artery injury?

A
  • Vascular or atherosclerotic disease in the elderly
  • Iatrogenic secondary to cross-clamping of aorta intraoperatively
32
Q

What are the clinical features of anterior cord syndrome?

A
  • Flaccid paralysis below level of lesion
  • Loss of pain/temperature
  • Autonomic dysfunction, including bladder, bowel, and sexual dysfunction
  • Preservation of modalities carried by dorsal columns, i.e. vibration, conscious proprioception, 2-point discrimination**​
33
Q

Is central cord syndrome always symmetrical?

A

No

34
Q

What are the causes of central cord syndrome?

A
  • Trauma
  • Disruption of blood flow to spinal cord
  • Cervical spinal stenosis
  • Degenerative spinal disease
  • Syringomyelia
  • Central canal ependyoma
35
Q

What trauma can cause central cord syndrome?

A
  • Hyperextension injury of cervical spine in elderly
  • Hyperflexion injury of cervical spine in younger patients
36
Q

How can degenerative spinal disease cause central cord syndrome?

A

Ligamentum flavum can compress the cord and cause contusions/bruising

37
Q

What is a central canal ependymoma?

A

Tumour arising from ependymal cells

look at me correcting the cards!!!

38
Q

What is the aetiology of syringomyelia?

A

Unknown

39
Q

What happens in syringomyelia?

A

Development of syrinx (cyst) in or within the central canal

40
Q

What do the initial symptoms of syringomyelia arise from?

A

The obliteration of spinothalamic fibres decussating in the white commissure

41
Q

What are the sensory symptoms of syringomyelia?

A

Loss of sensitivity painful and thermal stimuli in a cape-like distribution

Sensitivity to light touch and proprioception are preserved

42
Q

What are the clinical features of central cord syndromes?

A
  • Motor more affected than sensory
  • Upper extremity affected more than lower extremity
  • Distal affected more than proximal
  • Bladder dysfunction and urinary retention
43
Q

What does posterior cord syndrome affect?

A

Bilateral dorsal columns

44
Q

What causes posterior cord syndrome?

A
  • Spondylosis
  • Spinal stenosis
  • Infections
  • Vitamin B12 deficiency
  • Occlusion/infarction of the paired posterior spinal arteries
45
Q

What are the clinical features of posterior cord syndrome?

A
  • Loss of conscious proprioception
  • Loss of vibration sensation
  • Loss of two point discrimination
  • Loss of light touch
  • Motor function and sensation of pain, temperature, and firm touch intact
46
Q

How are spinal cord injuries managed non-surgically?

A
  • Consider intubation if C5 or above
  • ICU admission
  • Early immobilisation of the C-spine
  • C-spine restriction maintained for approx. 6 weeks
  • Physiotherapy/occupational therapy
47
Q

Why should you consider intubation if someone has a spinal cord injury at C5 or above?

A

Because there is a risk of loosing respiratory function, as loose the diaphragm function, and intercostal muscles tire quickly

48
Q

When should you consider surgery in spinal cord injuries?

A
  • Progressive neurological deficits
  • Unstable spinal fractures
49
Q

What approach should be taken in the initial evaluation and treatment of spinal cord injuries?

A

ABCDE

50
Q

When should you assume a spine injury has occured?

A
  • If head injury present
  • If unconscious or confused
  • If have spinal tenderness
  • If have extremity weakness
  • If have loss of sensation
51
Q

How should manual inline stabilisation be performed?

A
  • Crouching above the patient with hands placed on the patient’s mastoid processes or cradling their occiput, or
  • Standing beside the patient with hands on the sides of the patients head, and forearms resting on the patients chest
52
Q

How should c-spine be maintained in suspected spinal cord injury?

A
  • Log-roll
  • Backboard
  • Rigid C-collar
53
Q

How should hypoxia be addressed in spinal cord injuries?

A

Consider oxygen with or without airway adjuncts

54
Q

How should hypotension be addressed in spinal cord injuries?

A
  • Fluid challenge
  • Vasopressors
55
Q

How is the c-spine cleared?

A

NEXUS method -

  • Alert and orientated to person, place, time and event
  • No language barrier
  • Not intoxicated
  • No midline posterior tenderness
  • No focal neurological deficit
  • No painful distracting injuries

ESA 5 - Nervous System (18 decks)

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