SCI Flashcards
define spinal cord injury
a lesion or injury to the spinal cord due to bleeding, strain, bruising, or total disruption of the cord resulting in partial or complete loss of motor and/or sensory function below the level of injury
give examples of direct injuries
stab wound
gunshot
give an example of an indirect injury
fracture dislocations of the vertebrae
give examples of primary traumatic injuries
MVA
PVA
violence/assault
agricultural accidents
falls
give examples of secondary traumatic injuries
bleeding
swelling
inflammation
fluid accumulation
what are the three most vulnerable areas for SCI?
lower cervical (C5 - C7)
mid thoracic (T4 - T7)
thoracolumbar region (T10 - L2)
give examples of non-traumatic SCIs?
TB spine
Inflammation
neoplasia
degenerative disease
developmental problems
demyelinating diseases
vascular accidents
cysts
what is haematomyelia?
Hematomyelia is defined as the presence of a well-defined focus of acute hemorrhage within the central grey matter of the spinal cord itself. Trauma is the leading cause of hematomyelia. Once oedema subsides, pt should have function in the posterior and lateral columns. presentation is initially flaccid segmental paralysis, then spastic paralysis and segmental loss of pain and temp sensation.
what is the neurological level of injury?
the most caudal segment of the spine with normal sensory and motor function on both sides of the body
what is the motor level of injury?
the most caudal segment of the spine where motor function is normal bilaterally
what is the sensory level of injury?
the most caudal segment where sensory function is normal bilaterally
outline the presentation of an ASIA - A
no motor or sensory function is preserved in the sacral segments S4-S5
outline the presentation of an ASIA - B
sensory, but not motor function is preserved below the NLI and includes the sacral segments S4-S5
outline the presentation of an ASIA - C
motor function is preserved below the NLI and the majority of key muscles below the NLI have a muscle grade of <3
outline the presentation of an ASIA - D
motor function is preserved below the NLI and majority of key muscles below the NLI have a muscle grade of >3
outline the presentation of an ASIA - E
Motor and sensory function are normal
define anterior cord syndrome
damage to the anterior 2/3 of the spinal cord and preservation of the posterior columns. often caused by compression of the anterior spinal artery and damage to the corticospinal and spinothalamic tracts. Causes are generally flexion injuries or retropulsed disc or bone fragments.
SYMPTOMS:
variable loss of motor function, pain and temperature sensation below NLI. Proprioception, light touch, and deep pressure is preserved. Prognosis for LL function and ambulation is poor.
define central cord syndrome
damage to the central cord, usually due to unbelted MVAs and falls, results in anterior and posterior cord compression and is primarily due to microvascular compromise. It occurs almost exclusively in the cervical region. centrally located cervical tracts supplying the arms bear the brunt of the injury
SYMPTOMS:
motor and variable sensory loss UL>LL. flaccid paralysis in arms, spatic leg function. sacral sensation and B&B function is partially spared. favourable for ambulation and ADLs
define posterior cord syndrome
damage to the posterior 1/3 of the spinal cord, commonly seen in hyperextension injuries,
SYMPTOMS:
profound sensory and proprioception loss and difficulty with coordination - difficulty walking. motor function, pain, and temperature less affected.
define Brown-Sequard syndrome
damage (usually penetrating) to one side of the spinal cord causing ipsilateral hemiplegia and contralateral hemianaesthesia. recovery starts in ipsilateral proximal extensors, then distal flexors. good prognosis for ambulation.
SYMPTOMS:
ipsilateral: motor loss, loss of vibration, proprioception, form perception and two point discrimination.
contralateral: loss of pain, temperature, and light touch sensation
describe compression of the conus medullaris
usually occurs with the compression of L1, causes contusion and haemorrhage with damage to the sacral segments of the SC
S&S:
UMN and LMN symptoms
atulous anus leading to faecal incontinence
sensory loss in the sacral segments
urine retention with overflow
complete loss of male sexual function
describe compression of the cauda equina
damage to the spinal cord from L2-S5. Lesion results in mostly LMN damage. there is limited progressive recovery and ambulation prognosis is better than that of conus medularis.
S&S:
flaccid paralysis
muscle wasting
sensory loss
pain and hyperaesthesia
disturbance of bladder function
disturbance of sexual function and faecal incontinence
muscle fasciculations
loss of stretch reflexes
list the autonomic signs and symptoms following SCI
anhidrosis
loss of vasomotor tone
urine retention
horners syndrome
what is the expected functional recovery of C3/4?
- head and neckcontrol
- shrug shoulders
- initially requires a ventillator
difficulty with feeding
