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Neuro Rehab 2 > SCI - 1 intro > Flashcards

SCI - 1 intro Flashcards

1
Q

what are the most common causes of acquired SCI

A

MVAs
- then falls

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2
Q

what is the most common extent of SCI

A

incomplete tetraplegia

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3
Q

where does the spinal cord begin and end

A

extends from medulla oblongata to level of L1-2 disc

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4
Q

where does the conus medullaris end

A

terminal end somewhere between T12 and ‘L2
- L 2 is tip

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5
Q

what is the cauda equina

A

nerve roots dangling from L 2 thru S5

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6
Q

how will a SCI present above vs below conus medullaris/L2

A

above: CNS
- UMN s/sx w inc tone and refelxes

below: PNS
- LMN s/sx w low tone, hyporeflexia

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7
Q

where does the SC get it’s blood supply from

A

1 ant and 2 posterior spinal arteries

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8
Q

lateral corticospinal tract: innervates and function

A

ipsilateral

voluntary motion esp of distal limbs

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9
Q

ventral corticospinal tract: innervates and function

A

contralateral

axial ms (minimally)

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10
Q

rubrospinal tract: innervates and function

A

ipsilateral

motion of UE
especially precise, fine motor mvmts

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11
Q

vestibulospinal tract: innervates and function

A

bilateral

posture and balance

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12
Q

lateral and medial reticulospinal tract: innervates and function

A

ipsilateral

posture, balance, spinal reflexes, axial and proximal motions

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13
Q

anterolateral system (spinothalamic, spinoreticular, spinotectal tracts): innervates and function

A

contralateral

pain, temp, crude touch

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14
Q

dorsal column: innervates and function

A

ipsilateral

proprioception, vibration, deep & discriminative touch

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15
Q

dorsal spinocerebellar: innervates and function

A

ipsilateral

unconscious proprioception (trunk and LE)

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16
Q

ventral spinocerebellar: innervates and function

A

bilateral

unconscious proprioception (trunk and LE)

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17
Q

where does information in the lateral corticospinal tract cross and what does this mean for SCIs

A

crossed in pyramids

SCI will mean an ipsilateral loss of voluntary motion of distal limbs if damage in the SC

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18
Q

describe the anatomy behind how pinprick sensation is a good prognosticator for ambulation

A

lateral spinothalamic tract detects pain, so if can detect pinprick, tract is intact

lateral corticospinal tract = voluntary motion

literature says that if tract/sensation is intact below the level of SCI, inc likelihood of amb bc of close proximity of spinothalamic to lateral corticospinal tract
–> inc likelihood of resolution of edema and swelling and preservation of corticospinal tract –> regaining strength

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19
Q

what are 7 traumatic mechanism of SCI

A

flexion
hyper ext
compression
flexion/rotation
shearing
distraction
penetrating

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20
Q

what is an example of a hyperextension traumatic mechanism of SCI

A

fall forward and hit chin

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21
Q

what is an example of a compression traumatic mechanism of SCI

A

fall and land on feet

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22
Q

what is an example of a shearing traumatic mechanism of SCI

A

MVAs

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23
Q

what is an example of a distraction traumatic mechanism of SCI

A

pulled axillarily

24
Q

what is an example of a penetrating traumatic mechanism of SCI

A

GSW
stab wounds

25
Q

what are 5 factors that impact traumatic patterns of bony ligamentous damage in a SCI

A

body position
magnitude
rate of application
duration of force
point of force application

26
Q

what are the 2 most vulnerable areas of the spinal cord and why

A

C5-7
T12-L2

changes in angle so inc chance of moving and injury

27
Q

why are SCI most common in the cspine

A

poor mechanical stability
- not well supported by ms
- lot of mobility

28
Q

what are the 3 most common causes of a SCI in the tspine

A

gunshot wounds
MVA
falls

29
Q

rank the spines in order of stability

A

most
tspine
lumbar
cspine
least

30
Q

how vulnerable is the tspine to SCI and what does this often mean for tspine SCI

A

very stable bc of ribs, highly protected

only see damage if severe force of magnitude
- if damaged more likely to be complete
- if incomplete - GSW, stab wounds

31
Q

what are the 4 most common causes of lumbar SCIs

A

falls
MVA
gunshot wounds
crush injuries

32
Q

how vulnerable is the lumbar to SCI and why

A

intermediate level of stability d/t strong ms around it

33
Q

what are 6 non traumatic causes of SCIs

A

spinal hematoma
infection
radiation
neoplasm
vascular interruption
rheumatoid arthritis

34
Q

how can a spinal hematoma lead to a SCI

A

blood is toxic to nervous system
- also taking up space –> compression on SC

35
Q

how can radiation lead to a SCI

A

impacts neurologic tissue

36
Q

how can a neoplasm lead to a SCI

A

carcinogenic tissue can cause injury to nerves and SC

37
Q

what are types of vascular interruptions that can lead to a SCI

A

ischemia
hemorrhage

38
Q

how can RA lead to a SCI

A

bony changes

39
Q

why do you typically see a combo of presentations with SCI

A

not typical to have SCI in one area of spine

also more common for SCI to be incomplete

40
Q

what are 5 incomplete SCI syndromes

A

central cord
anterior cord
brown-sequard
conus medullaris
cauda equina

41
Q

central cord syndrome: typical cause, location, and pt pop

A

hyper extension injury –> crush and damage central part of SC from bleeding into central gray matter

cspine

older individuals w spinal stenosis / narrowing of canal
- more likely to see damage w hyper ext

42
Q

how does central cord syndrome typically present and why

A

UE more involved than LE
- d/t topographical orientation of homunculus (corticospinal UE more medial and LE more lateral)

impacting corticospinal (pinprick, strength of UE) and DCML (proprioception in both UE and LE) –> could still have 5/5 strength of LE

43
Q

what is the typical cause of anterior cord syndrome

A

flexion injury and teardrop fxs

44
Q

how does anterior cord syndrome typically present

A

loss of motor function and pain/temp sensation below injury

45
Q

what is the prognosis for anterior cord syndrome

A

poor for amb as corticospinal tract is hit
poor for bowel and bladder

46
Q

brown-sequard syndrome: what is damaged, how does it present

A

1/2 of SC damaged

ipsilateral proprioception and motor loss
contralateral loss of pain/temp sensation

47
Q

conus medullaris syndrome: what is damaged, presentation

A

injury of sacral cord (conus)

combo of UMNL and LMNL signs bc b/w central and peripheral
motor and sensory loss in LEs
areflexic bladder/bowel

48
Q

cauda equina syndrome: what is damaged, presentation

A

injury to lumbosacral nerve roots (LMNL)

LMNL bc more peripheral
- flaccid paralysis
- “saddle” paresthesia
- areflexic bladder/bowel

49
Q

what often causes the most damage to the SC

A

secondary sequelae of initial trauma

50
Q

what are 5 mechanisms of secondary tissue destruction

A
  1. ischemia
  2. inflammation and edema
  3. ion derangement w demyelination of axons
  4. neural cell death
  5. necrosis / apoptosis (necrosis replaced by scarring and cysts)
51
Q

what is spinal shock

A

transient physiological phenomenon
- sx in the first minutes to hours up to 1st week after trauma

depression or loss of SC function below level of injury (reflex arcs, motor, sensory, autonomic function) until reflex arcs below level of injury begin to function again
- loss of bulbocavernosus refelx, DTRs
- doesn’t imply state of circulatory collapse
- returns sooner in incomplete

eventually anything neurologically intact wakes up

52
Q

what influence does neurogenic shock have

A

impacts sympathetic ANS

53
Q

does the SC have to be severed for irreversible damage

A

no
- secondary sequelae can cause a lot of irreversible damage

54
Q

what is neurogenic shock

A

disruption of sympathetic nervous system outflow from T1-L2 leading to dec in vascular resistance w associated vascular dilation
- preserved parasympathetic system functioning

55
Q

what level of injury is neurogenic shock typically seen in and why

A

in injuries above T6, more in tspine levels

that is where the sympathetic nervous system lives
- parasympathetic lives in brain so that is why that function is often preserved

56
Q

neurogenic shock presentation and why

A

HoTN
- can get lifethreatening low
bradycardia
hypothermia

sx are based on blood flow in body that is diminished

can be life threatening

57
Q

how long do neurogenic shock sx last

A

up to 4-5wks

Neuro Rehab 2 (48 decks)

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