S3_L5: Spinal Cord Injuries Flashcards
Pott’s Disease is AKA?
Tuberculosis of the spine
Determine whether spinal or neurogenic shock is described
- Flaccid paralysis
- Hypotension, bradycardia, and hypothermia
- Hypotension occurs after
- Vasopressors may be indicated for this
- In injuries above T6
A. Spinal shock
B. Neurogenic shock
- A
- B
- A
- B
- B
Determine whether spinal or neurogenic shock is described
- Initial hypertension due to release of catecholamines
- Secondary to disruption of sympathetic outflow (T1-L2)
- Priapism may develop
- Bowel and bladder involved
- Loss of vasomotor tone
A. Spinal shock
B. Neurogenic shock
- A
- B
- A
- A
- B
Determine whether spinal or neurogenic shock is described
- Symptoms lasting several hours to days
- Blood pressure will not be restored by fluid infusion alone
- Transient reflex depression of cord function below injury level
- Massive fluid administration may lead to overload and pulmonary edema
- Loss of cardiac sympathetic tone
A. Spinal shock
B. Neurogenic shock
- A
- B
- A
- B
- B
What grading on the American Spinal Injury Association Scale is characterized by: Motor function preserved below level and power graded < 3?
Motor Incomplete
(first grade) or C
Note: This usually renders the patient unable to walk
What grading on the American Spinal Injury Association Scale is characterized by: No sensory or motor function preserved in sacral segments S4-S5?
Complete or A
What grading on the American Spinal Injury Association Scale is characterized by: Motor function preserved below level and power graded 3 or more?
Motor Incomplete
(second grade) or D
Note: This usually allows standing and walking
What grading on the American Spinal Injury Association Scale is characterized by: Sensory and motor function normal?
Normal or E
What grading on the American Spinal Injury Association Scale is characterized by: Sensory function is preserved but no motor function in sacral segments?
Sensory incomplete or B
Determine whether the injury described is a complete or incomplete SCI
- Loss of sensation & loss of voluntary movement of parts innervated by segment
- Some function is present below site of injury
- Recognizable patterns of injury, though they are pure and variations occur
- Favorable prognosis overall
- Spinal shock
A. Complete SCI
B. Incomplete SCI
- A
- B
- B
- B
- A
Determine whether Quadriplegia or Paraplegia is described
- Affectation of all 4 extremities
- Thoracic, lumbar, or sacral segments is involved
- Cervical region is involved
- Affectation of 2 extremities
A. Quadriplegia
B. Paraplegia
- A
- B
- A
- B
Match the myotome level with its corresponding innervation
- L4, L5, S1
- C7
- S1
- L3, L4
- C6
A. Ankle plantarflexion
B. Wrist extensors
C. Elbow extensors
D. Knee flexion
E. Knee extensors
- D
- C
- A
- E
- B
Match the myotome level with its corresponding innervation
- L2
- T1
- L5
- C5
- C8
A. Long finger flexors
B. Ankle dorsiflexion
C. Hip flexors
D. Small hand muscles
E. Deltoid
- C
- D
- B
- E
- A
Match the tract with its corresponding sensation / movement
- Pain and temperature
- Proprioception in joints and muscles
- Fine touch, proprioception, vibration
- Crude touch, pressure
- Skilled voluntary movements
A. Lateral corticospinal tract
B. Lateral spinothalamic tract
C. Anterior spinothalamic tract
D. Dorsal column medial lemniscus
E. Spinocerebellar tract
- B
- E
- D
- C
- A
Most common infectious condition leading to SCI in the Philippines
Pott’s Disease
What is used to treat bradycardia caused by a neurogenic shock?
Atropine
(Antimuscarinic drug)
Determine which incomplete SCI is described
- Compression of the cord by osteophytes & the ligamentum flavum
- Bony compression or disc protrusions in lumbar or sacral region
- Anterior Dislocation/Compression Fracture of a vertebral body
- Hyperextension injuries with fx of the posterior elements of the vertebra
- Caused by gunshot or stab wounds or fx of the lateral mass of the vertebra
A. Anterior Cord Syndrome
B. Brown-Sequard Syndrome
C. Cauda Equina Syndrome
D. Central Cord Syndrome
E. Posterior Cord Syndrome
- D
- C
- A
- E
- B
Determine which incomplete SCI is described
- Due to flexion / rotation
- Saddle paresthesia
- Ataxia and faltering gait, proprioception affected
- Caused by MVA, minor traumas, syringomyelia
- Hemi-section of the cord
A. Anterior Cord Syndrome
B. Brown-Sequard Syndrome
C. Cauda Equina Syndrome
D. Central Cord Syndrome
E. Posterior Cord Syndrome
- A
- C
- E
- D
- B
Determine which incomplete SCI is described
- Typical in older patients
- Stroke in the anterior spinal artery
- Leg numbness and weakness
- Motor paralysis and loss of proprioception and fine touch on affected side
- UE deficit is more severe than in the LE
A. Anterior Cord Syndrome
B. Brown-Sequard Syndrome
C. Cauda Equina Syndrome
D. Central Cord Syndrome
E. Posterior Cord Syndrome
- D
- A
- C
- B
- D
A neurological disorder in which a fluid-filled cyst forms within the spinal cord, leading to a slow degeneration of the spinal cord from the center.
Syringomyelia
Note: The fluid-filled cyst is also called a syrinx
What is the first spinal fiber tract to be involved in syringomyelia as the lesion enlarges?
Cervical
Note: This results in UE symptoms
A patient presents with a tumor compressing on the spinal cord. MRI findings show the tumor affecting the posterior column of the spinal cord.
Which spinal tract/s is/are affected first?
Cervical, thoracic, lumbar, and sacral tracts can be affected equally.
A patient presents with a tumor compressing on the spinal cord. MRI findings show the tumor affecting the lateral funiculus of the spinal cord.
Which spinal tract/s is/are affected first?
Lumbosacral tract
A patient presents with a tumor compressing on the spinal cord. MRI findings show the tumor affecting the ventral funiculus of the spinal cord.
Which spinal tract/s is/are affected first?
Sacral tract
It is an area of skin innervated by sensory axons within a particular segmental nerve root
Dermatome
It is a segmental nerve root innervating a muscle
Myotome
A muscle was tested for strength. It showed a flicker of movement.
What grade is given to this muscle?
1
A muscle was tested for strength. It had a full range of motion, but less than normal strength against resistance.
What grade is given to this muscle?
4
A condition characterized by an obstruction in the posterior cranial fossa that squeezes a portion of the cerebellum out the foramen magnum that results in the dilation of the ventricular system in the spinal cord, known as syringomyelia.
Arnold Chiari Malformation type I
Most common incomplete spinal cord lesion, also known as Schneider Syndrome and Walking Spinal Cord Injury
Central Cord Syndrome
TRUE OR FALSE, patients with cauda equina may present with back pain and bowel and bladder dysfunction
True
The dorsal column medial lemniscus and lateral corticospinal tract decussate where?
Medulla oblongata
The spinal cord extends from the medulla oblongata up to what location in adults and in children?
Adults: lower border of L1
Children: upper border of L3
The lower portion of the spinal cord is tapered, forming what structure?
Conus medullaris
How many pairs of spinal nerves are present in each section of the spine?
Cervical: 8
Thoracic: 12
Lumbar: 5
Sacral: 5
Coccygeal: 1
Total of 31 pairs
Which country is prone to spinal cord injuries, according to its statistics?
South Africa
Majority of spinal cord injuries are caused by?
Motor Vehicle Accident
Which one is NOT a mechanism of SCI?
A. Direct trauma
B. Ischemia from damage or impingement to spinal arteries
C. Viral or bacterial infections
D. Compression by bone fragments, hematoma, or disc material
C. Viral or bacterial infections
Compression to the spinal cord is most commonly caused by?
Disc disease
SCI is prevalent in what age range?
16-30 y/o
-Adolescent to early adulthood
SCI is prevalent in what sex?
Males
What is the most common presentation of diabetic neuropathy?
Combination of sensorimotor involvement
Where do the dorsal and ventral roots join to form the spinal nerve?
Intervertebral foramen
The ascending and descending tracts of the spinal cord are made up of (1)___ matter, while the sensory and motor nerve cells are made up of (2)___ matter.
- white
- gray
Symptoms from a spinothalamic tract lesion are found where?
On contralateral side
This is because the tract crosses in the spinal cord before ascending
In this syndrome, all functions in the lateral and ventral portion of the SC are affected, but function of posterior columns is spared.
Anterior Cord Syndrome
Corticospinal and spinothalamic tracts are damaged, but DCML is intact
What are the expected findings in anterior cord syndrome?
Loss of power and decrease in pain & sensation below the level of lesion
In Brown-Sequard Syndrome, pain and temperature loss is seen on which side below the lesion?
Contralateral side to lesion
Due to spinothalamic tract crossing over
In Brown-Sequard Syndrome, motor paralysis is seen on which side?
Ipsilateral side to lesion
In Brown-Sequard Syndrome, loss of proprioception and fine discrimination is seen on which side?
Ipsilateral side to lesion