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UM - Neuro Conditions > SCI > Flashcards

SCI Flashcards

1
Q

What is the leading cause of death for those w/SCI?

A

Pnemonia and septicemia (respitory illnesses)

With wound infections following closely

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2
Q

From C1-C7, the nerve root exits ___ the vertebrae

A

Above the vertebrae

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3
Q

From C8 and below, the nerve root exits ___ the vertebrae

A

Below the vertebrae

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4
Q

Which nerves have no dorsal root or dermatome?

A

Coccygel nerve and C1

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5
Q

Define thrombosis

A

Local coagulation or clotting of the blood

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6
Q

Define embolus

A

A blood clot, air bubble, piece of fatty deposit, or other obj which has been carried in the bloodstream to lodge in a vessel and cause an embolism

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7
Q

Define arteriovenous malformation

A

An abnormal connection between arteries and veins, usually in the brain or spine.

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8
Q

What does ASIA stand for

A

American Spinal Injury Association

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9
Q

What does ISNCSCI Stand for

A

International standards for neurological classification of SCI

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10
Q

What does AIS stand for

A

ASIA impairment scale

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11
Q

Define sacral sparing

A

The presence of sensory or motor function in the most caudal sacral segments as determined by examination (S4-S5 light touch or pin prick or presence of DAP)

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12
Q

ASIA key mm for:

C5

A

Elbow flexors (biceps)

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13
Q

ASIA key mm for:

C6

A

Wrist extensors

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14
Q

ASIA key mm for:

C7

A

Elbow extensors

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15
Q

ASIA key mm for:

Finger flexors

A

Middle digit flexion at the DIP

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16
Q

ASIA key mm for:

T1

A

Little finger abduction

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17
Q

ASIA key mm for:

L2

A

Hip flexors

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18
Q

ASIA key mm for:

L3

A

Knee extensors

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19
Q

ASIA key mm for:

L4

A

Ankle DF

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20
Q

ASIA key mm for:

L5

A

Long toe extensors (big toe tested)

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21
Q

ASIA key mm for:

S1

A

Ankle PF

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22
Q

Which levels are there no key mm for ASIA testing?

A

C1-C4, T2-L1, S2-5

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23
Q

What does a violation of the N0000N sign indicate?

A

Incomplete

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24
Q

What is tenodesis grip?

A

A flexion contracture developed in the fingers so that when wrist extension is performed, the fingers will flex - allows for grip in individ w/o finger mm

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25
Q

T or F: More SCI injuries are female

A

False - 78% male

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26
Q

Race/Ethniciy of those affected w/SCI (High to low)

A 
Non-hispanic white
Non-hispanic black
Hispanic
Asian
Other
Native American
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27
Q

Cause of SCI (High to low)

A 
Vehicular
Falls
Violence
Sports
Med/Sx
Other
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28
Q

Extent of SCI (High to low)

A

Incomplete tetraplegia
Complete Paraplegia
Incomplete Paraplegia
Complete Tetraplegia

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29
Q

What is the average age of injury for SCI

A

43

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30
Q

How many cases per million in the US

A

54

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31
Q

How many people in US with SCI

A

296,000

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32
Q

Complete vs incomplete lesion

A

Loss of all sensation and motor function below the level of the lesion vs only partial loss below the level of lesion

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33
Q

Define tetraplegia

A

Impairment or loss of motor function and/or sensory function in the cervical segments of the SC due to damage of neural elements w/in the spinal canal

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34
Q

Define paraplegia

A

Impairement or loss of motor and/or sensory function in the thoracic, lumbar, or sacral (NOT CERVICAL) segments of the SC due to damage of neural elements within the spinal canal

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35
Q

Length of stay:
Acute care
Rehab

A

11 days

30 days

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36
Q

Which layer of the meninges is avascular

A

The arachnoid mater

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37
Q

Which type of SCI has the best prognosis?

A

Contusion because the SC is still intact

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38
Q

What is a contusion injury

A

Bruising of the SC following fx and dislocations of the vertebrae

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39
Q

Causes of compression injury

A

From fx and dislocations of vertebrae, tumors, disc herniation

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40
Q

What is the clinical presentation of a contusion

A

Initially severe symptoms but usually a relatively rapid return of function, dependent upon the severity of the injury

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41
Q

What is a laceration

A

SCI injury due to knife, gunshot, or other projectile/foreign object

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42
Q

What is the clinical presentation of a laceration injury

A

Partial to complete loss of function below level of lesion w/impairment dependent upon the extent of the lesion

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43
Q

What is a loss of vascular supply lesion

A

SCI from thrombosis, embolus, arteriovenous malformation or direct disruption of blood vessels

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44
Q

What is the clinical presentation of a loss of vascular supply lesion

A

Partial loss of SC fun below the level of the lesion in distribution of blood supply

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45
Q

At T6, what would you find in the PCML?

A

T6-S5 nerve information

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46
Q

What does damage below the level of L2 lead to?

A

Damage is to the nerve roots only due to the SC ending at L2 bony level

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47
Q

What does a hyperflexion injury cause?

A

Anterior Cord Syndrome

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48
Q

What does a hyperextension injury cause?

A

Posterior cord syndrome

49
Q

What causes anterior cord syndrome

A

Loss of blood flow to anterior spinal cord artery, damage to the anterior 2/3 of SC, hyperflexion injury

50
Q

What is anterior cord syndrome

A

Partial or full loss of bilateral ALS, lateral and anterior CST below level of lesion, but spared PCML bilaterally below level (preservation of light touch and joint position sense)

51
Q

What is posterior cord syndrome

A

Loss of DCML sensory modalities below the level of lesion, preservation of ALS sensation, and partial or full preservation of CST motor function bilaterally

52
Q

What is central cord syndrome

A

Central SC hemorrhage and necrosis with sparing of the peripheral areas of the SC - most often in the cervical region w/greater weakness in UE than LE

53
Q

What is the most common clinical syndrome SCI

A

Central cord syndrome

54
Q

What is Brown-Sequard Syndrome

A

Hemisection of the SC causing
IPSI DCML and CST loss (prop, vibration, fine touch, motoro control)
CL ALS loss (crude touch, sharp/dull, T, pain, tickle and itch)

55
Q

What are the most common mechanisms of injury for Brown-Sequard

A

Traumatic SCI - penetrating injuries (Gunshot, knife wound) or a burst fx

56
Q

What is cauda equina syndrome

A

Involves lumbosacral nn roots of cauda equina, causing LMN damage

57
Q

Symptoms of Cauda Equina Syndrome

A

producing:

  • flaccid paralysis of LEs
  • areflexic bowel and bladder
  • partial or complete loss of sensation
58
Q

Difference b/t conus medullaris syndrome and cauda equina syndrome

A

Conus medullaris is more rostral in the SC (L1-L2)

59
Q

What is conus medullaris syndrome?

A

Damage to the SC w/UMN and LME damage (Depending on level of injury) - typically more rostral than cauda equina

60
Q

What is Acute Transverse Myelitis

A

SC lesion usually in the thoracic spine, where 1/3 recover complete, 1/3 partial, and 1/3 not at all

Initially presents w/fever, headache, nausea and vomiting, lethargy, and myalgias

61
Q

What is a Complete Injury?

A

Loss of sensation and motor function below level of lesion w/absence of sacral sparing and 0s for light touch/pinprick (S4-5)

62
Q

What is an incomplete injury?

A

Partial loss of sensation and motor fun below level of injury where Sacral sparing is present

63
Q

What is AIS A

A

Complete SCI

- No sensory or motor fun preserved in sacral segments S4&5, and often none below the level of injury

64
Q

What is AIS B

A

Sensory Incomplete

  • sensory, but not motor fun preserved @ most caudal segments (absent N0000N sign)
  • NO MOTOR FUN preserved MORE THAN 3 levels below motor level
65
Q

What is AIS C

A

Motor Incomplete

  • Motor fun is preserved in the most caudal sacral segments (Voluntary anal contraction)
  • > 1/2 of key mm fun below level of injury have mm grade <3
  • some sensory fun at S4-5 (DAP, PP, or LT)
66
Q

AIS D

A

Motor Incomplete

  • At least 1/2 of key mm fun below single NLI have muscle grade >= 3
67
Q

AIS E

A

Normal

  • sensation and motor fun are graded normal in all segments
68
Q

What is the use of non-key muscles in the AISA exam?

A

To differentiate b/t AIS B vs C w/non-key mm >3 levels below the motor level on each side

69
Q

Pt presentation with:

C2-C3

A

Ventilator dependent, total care

70
Q

Pt presentation with:

C3-5

A

Phrenic nn, independent breathing, off ventilator

71
Q

Pt presentation with:

C5

A

Can raise shldrs and flex arm to use joystick on power w/c - possibly manual w/c + adaptations

72
Q

Pt presentation with:

C6

A

Have wrist ext so weak, funct tenodesis grasp

73
Q

Pt presentation with:

C7

A

Have triceps and can preform P relief and transfers to help self prevent ulcers

74
Q

Pt presentation with:

Thoracic region

A

Adds postural stability and respiration function

75
Q

Pt presentation with:

T6-T12

A

abdominal function

76
Q

Pt presentation with:

L2

A

Hip flexion

77
Q

Pt presentation with:

S2-4

A

Sacral region is important for bowel/bladder/sexual function

78
Q

What do you do w/acute SCI MGT

A
  • check ABC
  • Log roll (NEUTRAL SPINE)
  • Immobilize
  • Monitor BP & ECG
  • X-ray, CT and/or MRI
79
Q

Indications for Sx w/acute SCI

A
  • Bone fragments and disk material in spinal canal
  • Unstable fx
  • Progression of neuro deficit
  • Decompression due to edema, increased blood in area, etc
80
Q

Goals of sx

A
  1. Stabilize
  2. Decompress Neural elements
  3. Correct deformity and/or maintain alignment
81
Q

What are harrington rods

A

Stainless steel rods w/hooks on either end placed on either side of injury

  • away : traction
  • towards : Compression
82
Q

What is the most common approach for TL Sx?

A

Posterior approach

83
Q

Where is an anterior approach more common?

A

Cervical spine

84
Q

How long do you immobilize for

- Stable fx w/o sx

A

6-12 weeks

85
Q

How long do you immobilize for

- Cervical Fusion

A

3-4 months using halo or SOMI

86
Q

How long do you immobilize for

- Thoracolumbar Fusions

A

4-6 mo using a rigid body jacket (TLSO)

87
Q

What is spinal shock?

A

Onset: Immediate
Duration: 1 wk - months
W/FLACCID paralysis & loss of sensation below level of lesion, absent bowel and bladder tone, and decreased BP

88
Q

What is the zone of injury & why is it important

A
  • 1-3 neurological levels below the neurological level of injury.
  • Important because this area has the most potential for recovery
89
Q

Define spasticity

A

A motor disorder characterized by a velocity dependent increase in tonic stretch reflexes with exaggerated deep tendon reflexes resulting from the hyper–excitability of the monosynaptic stretch reflex as one component of the UMN syndrome

90
Q

Relationship b/t spasticity and function

A 
Inversely proportional 
(Increase spasticity = decrease function)
91
Q

T or F: Spasticity is constant throughout the day

A

F - spasticity can change based on many factors, including t of day, position, meds, T, mood, fatigue, etc

92
Q

Spasticity in your patient is greater than usual - what do you do?

A

Investigate it

  • UTI?
  • Noxious stimulus
  • syrinx (increased swelling in tissue that is compromising the SC)
  • Use baclofen as a first line agent
93
Q

What is synrinx?

A

It is increased swelling in tissue that is compromising or pressing on the SC - concern if spasticity is greater than usual

94
Q

What kind of rehab interventions would you utilize for spasticity?

A
  • Position on a consistent basis
  • Modalities
  • Ther ex
  • Orthotic management
95
Q

What is a DEXA scan used for?

a) score of >= -1
b) score of -1 - -2.5
c) score < -2.5

A

Classification of osteoporosis/osteopenia

a) normal
b) osteopenia
c) osteoporosis

96
Q

List some interventions for Osteoporosis

A
  • WB in all positions
  • Easyglide
  • FES Cycling
  • Vitamin D / CA+ supplement
  • Obesity reduction
97
Q

What is heterotopic Ossification

A

Ca++ Deposits in soft tissues around joints that receive stress causing a limitation of ROM

98
Q

What is a dysrhythmia?

A

Abnormality in the physiological rhythm of the heart

99
Q

What is hypertension?
Hypotension?
(Values)

A

> 140/90 mmHg

< 90 mmHg systolic

100
Q

What is orthostatic hypotension

A

Symptomatic or asymptomatic decrease in BP w/drop of at least 20 mmHg systolic or 10 mmHg diastolic w/in 3 minutes of moving

101
Q

What are the symptoms of orthostatic hypotension (per ASIA)

A

dizziness, headache, or neck ache and fatigue

  • others are lightheadedness, generalized weakness, leg buckling, nausea, blurry or “fading to black vision”
102
Q

What causes orthostatic hypotension?

A
  • Loss of sympathetic input below level of lesion
  • Failure of body to compensate for drop in BP
  • Loss of mm pumping action to return blood from LEs
103
Q

Define autonomic dysreflexia (AD)

A

Massive sympathetic hyperactivity in response to noxious stimuli below the level of the SC injury in complete SCI above T6

104
Q

What triggers AD?

A
  • Full bladder/blocked catheter
  • Tight clothing
  • Prolonged pressure by object (tight shoe, ill fitting brace)
  • UTI, pain, sunburn, pressure injuries, ingrown toenails
105
Q

What are the s/s AD?

A
  • Pounding headache (**from elevation of BP)
  • Flushed face w/blotching of skin
  • Goosebumps & standing hairs
  • sweating above injury & vasoconstriction below injury
106
Q

What are some complications of AD?

A

Seizures
CVA
Organ Failure
Death

107
Q

Sweating - what occurs above and below the level of the lesion?

A
  • hyperhydrosis above lesion in response to noxious or non-noxious stimuli
  • hypohydrosis below in response to increased T
108
Q

Define Temperature dysregulation

A

change in body (core) temperature without signs of illness or infection which may result from environmental temperature change

109
Q

Why can a person w/SCI not regulate their temp?

A

Because they cannot sweat or shiver below the level of the lesion

110
Q

T or F: Those w/SCI have a decreased risk of DVT

A

False - they have an increased risk

111
Q

At C8-T12, approx what respiratory vital capacity do pts lose?

A

20-70% decrease in capacity

112
Q

List the urological system complications from SCI

A
  • UTI
  • Kidney stones
  • Bladder stones
113
Q

List the gastrointestinal complications from SCI

A
  • Loss of bowel control
  • constipation or obstruction
  • bowel accidents due to medications treating constipation
114
Q

How do you manage gastrointestinal complications from SCI?

A

Surgically via colostomy or ileostomy

115
Q

What is true about the reproductive system in women post SCI?

A
  • will return to menses (50% after 6mo, 90% 1 yr)

- can get pregnant even if can’t feel below level of injury

116
Q

What nerves control reflexogenic erections?

A

S2-4

117
Q

What is neuropathic pain?

Who experiences it?

A

Burning sensation below the level of lesion felt by 70-90% (MOST) SCI pts

118
Q

How long does it take to get a pressure injury over a bony prominence?

A

32 mmHg in as little as 30 min

119
Q

How much pressure can lead to necrosis in >2 hrs

A

70 mmHg

UM - Neuro Conditions (12 decks)

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