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Neurology > SCI > Flashcards

SCI Flashcards

1
Q

define spinal cord injury

A

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

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2
Q

give examples of direct injuries

A

stab wound
gunshot

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3
Q

give an example of an indirect injury

A

fracture dislocations of the vertebrae

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4
Q

give examples of primary traumatic injuries

A

MVA
PVA
violence/assault
agricultural accidents
falls

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5
Q

give examples of secondary traumatic injuries

A

bleeding
swelling
inflammation
fluid accumulation

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6
Q

what are the three most vulnerable areas for SCI?

A

lower cervical (C5 - C7)
mid thoracic (T4 - T7)
thoracolumbar region (T10 - L2)

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7
Q

give examples of non-traumatic SCIs?

A

TB spine
Inflammation
neoplasia
degenerative disease
developmental problems
demyelinating diseases
vascular accidents
cysts

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8
Q

what is haematomyelia?

A

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.

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9
Q

what is the neurological level of injury?

A

the most caudal segment of the spine with normal sensory and motor function on both sides of the body

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10
Q

what is the motor level of injury?

A

the most caudal segment of the spine where motor function is normal bilaterally

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11
Q

what is the sensory level of injury?

A

the most caudal segment where sensory function is normal bilaterally

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12
Q

outline the presentation of an ASIA - A

A

no motor or sensory function is preserved in the sacral segments S4-S5

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13
Q

outline the presentation of an ASIA - B

A

sensory, but not motor function is preserved below the NLI and includes the sacral segments S4-S5

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14
Q

outline the presentation of an ASIA - C

A

motor function is preserved below the NLI and the majority of key muscles below the NLI have a muscle grade of <3

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15
Q

outline the presentation of an ASIA - D

A

motor function is preserved below the NLI and majority of key muscles below the NLI have a muscle grade of >3

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16
Q

outline the presentation of an ASIA - E

A

Motor and sensory function are normal

17
Q

define anterior cord syndrome

A

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.

18
Q

define central cord syndrome

A

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

19
Q

define posterior cord syndrome

A

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.

20
Q

define Brown-Sequard syndrome

A

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

21
Q

describe compression of the conus medullaris

A

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

22
Q

describe compression of the cauda equina

A

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

23
Q

list the autonomic signs and symptoms following SCI

A

anhidrosis
loss of vasomotor tone
urine retention
horners syndrome

24
Q

what is the expected functional recovery of C3/4?

A
  • head and neckcontrol
  • shrug shoulders
  • initially requires a ventillator
    difficulty with feeding
25
Q

what is the expected functional recovery of C5

A
  • biceps present
    independence with eating, drinking, washing and personal hygiene with assistive devices
  • pushing a wheelchair for short distances
  • self assisted coughs
    independent pressure relief
  • may drive an adapted car
26
Q

what is the expected functional recovery of C6

A
  • can extend wrists
  • tenodesis grip
  • independent with most ADLs
  • independent with manual wheelchair - may need a transfer
  • may independently do B&B management
27
Q

what is the expected functional recovery of C7

A
  • intact triceps and most of lattisimus dorsi
  • may need assistance with cutting food
  • independent with manual wheelchair - without transfer board
  • can do wheelchair tricep dips for pressure relief
28
Q

what is the expected functional recovery of C8-T1

A
  • better use of fingers (flexor digitorum profundus and abductor digiti minimi)
  • all of lattisimus dorsi
  • can perform ADLs without assistive devices
29
Q

what is the expected functional recovery of T2-T6

A
  • full UL use
  • better trunk control
30
Q

what is the expected functional recovery of T7-T12?

A
  • better abdominal control
  • better coughing
  • functional unsupported sitting
31
Q

what is the expected functional recovery of L1-L5

A
  • good supported static standing balance
  • L1-2 calipers with crutches
  • L4-5 crutches and AFO
32
Q

what is the expected functional recovery of S1-5

A
  • uncommon
  • independent walking
  • possible loss of bladder and bowel and sexual functions
33
Q

what is autonomic dysreflexia

A

AD is a syndrome of massive imbalanced reflex sympathetic outflow occurring with damage above the splanchnic sympathetic outflow (T5-T6). It causes an exaggerated response to stimuli, releasing neurotransmitters and resulting in acute emergency. The increased ICP and BP can lead to cerebral hemorrhage and death. Occurs after spinal shock has resolved.
S&S:
increased sytolic and diastolic BP
profuse sweating
headache
bradycardia
flushing of the skin
piloerection
nausea
blurry vision

34
Q

what causes AD?

A

distended bladder (most common)
pressure, pain, heat or cold
bowel over-distension
skin related disorders
sexual activity

35
Q

management of AD

A
  • remove the stimulus
  • sit pt upright with feet down to promote orthostatic reduction of BP
  • loosen clothing/ constrictive devices
  • monitor catheter for blockage/twisting

Neurology (7 decks)

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