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Head, Neck And Neuro > PBL - Spinal Shock And Spinal Injury > Flashcards

PBL - Spinal Shock And Spinal Injury Flashcards

1
Q

Temporary suppression of all reflex activity below the level of injury describes what?

A

Spinal shock

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2
Q

When does spinal shock occur?

A

Immediately after injury

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3
Q

The return of what reflex indicates the end of spinal shock?

A

Bulcocavernosus reflex

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4
Q

What are the clinical effects of spinal shock?

A

Flaccid paralysis
Areflexia
Loss of sensation
Loss of bladder and bowel reflexes

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5
Q

What are the phases of spinal shock?

A

Areflexia
Initial reflex return
Initial hyperreflexia
Hyperreflexia and spasticity

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6
Q

How is the motor function of someone with a spinal cord injury assessed?

A

ASIA charts

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7
Q

How is sensory function after a spinal cord injury assessed?

A

Pin prick
Light touch
Sacral sparing

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8
Q

Who are the people involved in caring for someone with a spinal injury?

A

Spinal injury unit
Physiotherapist
Occupational therapist
Family

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9
Q

What is the role of the physiotherapist in spinal cord injury rehabilitation?

A

Teaches wheelchair skills, helps relearn balance, strengthens paralysed muscles and teaching to transfer skills

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10
Q

What is the role of the occupational therapist in spinal cord injury rehabilitation?

A

Helps patients reach high level of physical and psychological independence at home and work
Help with wheelchairs, computer aids and other tools

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11
Q

What is the role of the family in spinal cord injury rehabilitation?

A

Helps with income support, modifying homes, facilitates community nursing care

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12
Q

In which of an upper motor neuron lesion or a lower motor neuron lesion, is there muscle wasting?

A

Lower

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13
Q

In which of an upper motor neuron lesion or a lower motor neuron lesion, is there fasciculations?

A

Lower

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14
Q

Describe the tone in both an upper motor neuron lesion and a lower motor neuron lesion

A

Lower motor neurons lesions lead to flaccid tone

Upper motor neurons lesions lead to spastic tone

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15
Q

Describe the weakness/paralysis seen in both an upper motor neuron lesion or a lower motor neuron lesion

A

Lower - loss of muscle bulk

Upper - ineffective recruitment of alpha motor neurons

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16
Q

Describe tendon jerk reflexes in both upper and lower motor neuron lesions

A

Lower - reduced or absent

Upper - hyperreflexia

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17
Q

What happens to respiration if C3, 4 or 5 are damaged?

A

Phrenic nerve damage - innervates diaphragm

Patient will need artificial ventilation to survive

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18
Q

What happens to respiration is C6 or C7 are damaged?

A

These nerves innervate the intercostal muscle
- paradoxical breathing
Phrenic nerve remains intact

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19
Q

What happens to respiration if T1 or below are damaged?

A

No effect

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20
Q

How much movement can be achieved if there is a spinal injury at C4?

A

None below the neck - quadriplegia

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21
Q

How much movement can be achieved if there is a spinal injury at C5?

A

There will be some control of the should and biceps

No wrist or hand control

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22
Q

How much movement can be achieved if there is a spinal injury at C7-T1?

A

They will be able to straighten their arms

May have dexterity problems with their hands and fingers

23
Q

How much movement can be achieved if there is a spinal injury at T1-T8?

A

There will be paraplegia - full use of arms
Poor control of the trunk as the abdominal muscles are effected
Balance while still quite good

24
Q

How much movement can be achieved if there is a spinal injury in the lumbar of sacral regions?

A

Decreased control of hip flexors and legs

25
Q

Do patients often lose their micturition reflex?

A

Not unless the lumbrosacral region of the cord is damaged

- if the injury avoids damaging this area, the reflex will remain intact, or recover after a few weeks

26
Q

What is the ‘autonomic bladder’

A

Sensory bombardment of the cord from stretch receptors

- bladder emptying occurs when threshold is reached

27
Q

How can micturition be indirectly controlled?

A

Patient increases sensory bombardment of sacral region by scratching the inner thigh, facilitating the reflex

28
Q

Do somatic reflexes return after spinal injury?

A

Despite the fact that voluntary control of muscle never returns
- somatic reflex do

29
Q

Which reflexes return first?

A

Ankle
Knee
Hip
- in sequence

30
Q

Extensor reflexes return around 6 months after transection- what is different about them?

A

Exaggerated - leading to spastic paralysis

31
Q

Describe autonomic dysrreflexia.

A

Stage of reflex activity that follows primary flaccidity of the shock
Due to massive sympathetic discharge
Trivial stimulus to body below the level of injury can trigger it

32
Q

Signs and symptoms of autonomic dysrreflexia

A 
Sweating 
Increased heart rate
Hypertension
Defecation
Erection
Micturition
33
Q

What happens to blood pressure when the bladder fills in people with a spinal cord injury?

A

It increases - flushed face seen on urination

34
Q

Does autonomic dysrreflexia resolve?

A

Primitive control of autonomic function is re-established

- BP control remains more unstable than in normal people

35
Q

What happens to the Babinski response reflex after spinal cord injury?

A

It initially disappears - and when it comes back, it occurs only in the abnormal form (positive response)

36
Q

Which reflexes permanently disappear in a spinal cord injury?

A

Abdominal reflexes

Cremasteric reflexes

37
Q

In development, what do the alar and basal plates of the spinal cord become in humans?

A

Alar - dorsal horn

Basal - ventral horn

38
Q

What are the diagnostic reasons you would perform a lumbar puncture?

A

Withdrawal CSF

Measure CSF pressure

39
Q

What are the therapeutic reasons you would perform a lumbar puncture?

A

Administration of antibiotics

Chemotherapy

40
Q

Where would you perform a lumbar puncture?

A

Between L3 and L4 or between L4 and L5

41
Q

What is the surface marker for the body of L4?

A

Supracristal line passes through the body of L4

42
Q

In which part (superficial or deep) of the dorsal horn do the spinothalamic and dorsal column tracts terminate?

A

Spinothalamic - superficial

Dorsal column - deep

43
Q

Which descending tracts are involved in muscle movement?

A

Corticospinal and corticobulbar

44
Q

What descending tracts are involved with muscle tone maintainance?

A

Reticulospinal
Tectospinal
Vestibulospinal

45
Q

What commonly causes central cord syndrome?

A

Hyper extension injuries

Compression of the cord anteriorly by osteophytes and posteriorly by ligamentum flavum

46
Q

Describe what brown-sequard syndrome is, and what commonly causes it.

A

Hemi-section of the cord

  • stab wounds
  • gunshot wounds
47
Q

What does brown-sequard syndrome appear as clinically?

A

Paralysis on affected side (corticospinal)
Loss of proprioception and fine discrimination (dorsal column) on affected side
Loss of pain and temperature loss on the opposite side (spinothalamic)

48
Q

What causes cauda equina syndrome?

A

Due to bony compression or disk protrusion in the lumbar or sacral regions

49
Q

What clinical symptoms arise from cauda equina syndrome?

A

Back pain
Bowel and bladder dysfunction
Leg numbness/weakness
Saddles parasthesia

50
Q

What is neurogenic shock?

A

The body’s response to the sudden loss of sympathic control

  • occurs in people who have a T6 injury or above
  • occurs in those who have a greater than 50% loss of sympathetic innervation
51
Q

What is the clinical triad for neurogenic shock?

A

Hypotension
Bradycardia
Hypothermia

52
Q

What is the desired BP to assure good perfusion of the injured spinal cord?

A

85mmHG MAP

53
Q

What are people with a spinal cord injury high risk for, and require prophylaxis for?

A

DVT

Pulmonary embolism

Head, Neck And Neuro (19 decks)

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