SCI

Question 1

what are causes of SCI

Answer 1

traumatic = vehicle accidents, acts of violence, falls, sports + recreation
non-traumatic = diseases

Question 2

describe dorsal column spinal tract

Answer 2

• ascending (sensory) info eg: fine touch, pressure + proprioception
  from spinal cord, to thalamus
  decussation = brainstem

Question 3

spinothalamic tract

Answer 3

ascending (sensory info eg pain, temp, crude touch
from spinal cord, to thalamus
decussation = spinal cord

Question 4

spinocerebellar tract

Answer 4

ascending (sensory) info = proprioception
from spinal cord to cerebellum
decussation = ipsilateral input, direct and indirect pathway, indirect pathway decussates twice

Question 5

corticospinal (pyramidal) tract

Answer 5

descending (motor) info = voluntary control
from cerebral cortex to spinal cord
decussates = brainstem (pyramids)

Question 6

what are the types of spinal cord injury and mvm
+ common cord injuries

Answer 6

mvm = flexion, compression + hyperextension
results from accel/deceleration forces
most common = C1-C2, C4-C6 + T11-L2 (most mobile parts)

Question 7

describe severity/level of injury based on site

Answer 7

cervical (quadriplegia)
- c1-c4 = life threatening diaphragm
- c5-c7 = mvm in neck, shoulders, scpula + inc arm mvm closer to c7
thoracic + lumbar (paraplegia)
- t1-t12 transection injury => paraplegia, t12 can regain ambulation like lumbar and sacral

Question 8

what is the classifaction of SCI

Answer 8

american spinal injury assocation (ASIA)
touch + pinprick sense in each dermatome
test strength of 10 key muscles on each side of body

Question 9

what is central cord syndrome

Answer 9

cervical injuries only
damage = ischaemia, haem, necrosis of central portions of spinal cord
spared = corticospinal tracts
impair = mvm arms + hands

Question 10

anterior cord syndrome

Answer 10

flexion injuries
damage = anterior portion SC/ block blood supply from atnerior spinal artery
spared = dorsal columns (fine touch, vibration, proprioception)
impairment = below injury motor func, pain, temp

Question 11

brown-sequared syndrome

Answer 11

damage = hemisectioned damage exclusively to one lateral side
impair on ipsilat = motor function, dorsal columns
impair on contralat = pain, temp, crude touch bc spinothalamic decussates at spine

Question 12

what is primary injury

Answer 12

contusion, compression, lacerations, shearing stretching
haem in central grey matter, inc in size over time
haem max at injury site, extends towards head and feed

Question 13

describe secondary injury

Answer 13

• Neuropathologic changes - haemorrhage, oedema, neuronal necrosis, axonal
fragmentation, demyelination, and eventually cyst formation
• Vascular changes – ischemia, reduced SCBF, BSCB permeability
• Biochemical alterations - ↑ Na+ & Ca2+↓ K+
, cytotoxic oedema, halt mitochondrial
ATP production.
• Apoptosis
• Excitotoxicity – Glutamate release
• Lipid peroxidation/free radical injury
• Immune response – complement cascade, macrophage infiltration, activated
microglia and astrocytes.

Question 14

signs and symptoms

Answer 14

loss mvm, sensation (heat/cold/touch)
pain
loss bowel/bladder control
inc reflex/spasm
changes to sex function/fertility
difficulty breathing, coughing
age-related defecits bc now have longer life expectancy

Question 15

what is autonomic dysreflxia

Answer 15

50-90% tetraplegics
stim symp nervous system = uncompensate cardio response
hypertension, headache, blurred vision, bradycardia, dilation skin blood vessels, flushing, sweating, congetion, nausea

Question 16

autonomic dysreflexia causes + treatments

Answer 16

impaction of bowels, distention of bladder, pressure sores
remove stimulus, low bp
life threatening

Question 17

management of SCI

Answer 17

scene = stabilisation (boards, sometimes pressure sores, hard collars)
hospital = surgery to decompress, pharm + non pharm interventions
rehab = locomotor training

Question 18

early vs late decompression

Answer 18

early = shorter hospital stay, less ventilation + pulmonary complications + cost reduce, effect greater in more serious injury
= better than late

Question 19

describe pharm interventions for SCI

Answer 19

methylprenisolone - syntethic glucocorticoid (controversial)
- in atni flam cytokine release + reduce lipid peroxidation
- administered with 8 hr post injury, otherwise worse outcomes (gastro haem. resp infect)
riluzole = Na chan block = prevents excitotoxicity
not yet approved

Question 20

what are non pharm interventions for SCI - CSF drainage + MABP augmentation

Answer 20

remove V from space around spinal coloumn => dec presh => improve blood flow
inc mabp -> inc perfusion spinal cod
decrease intrathecal presh?

Question 21

what are non pharm interventions for SCI - therapeutic hypothermia

Answer 21

buy time
inc healthy tissue in peri-inury region
inc sparrking grey + white matter damage within injury site
improves functional outcome

Question 22

describe some novel regenerative approaches

Answer 22

electrical stimulation
delivery nanosystems
cell therapy
biomolecules
bioscaffold

Question 23

what is the prognosis/recovery of SCI

Answer 23

heterogeneous = hard to predict outcome
type, severity, incomplete/complete
improvement occurs 6-18months post injury
sometimes deteriorate over time