SCI

Question 1

Plegia

Answer 1

Complete lesion

No strength

Question 2

Paresis

Answer 2

some muscle strength is preserved

Question 3

What are the layers of the meninges?

Answer 3

dura mater
arachnoid mater
pia mater

Question 4

Describe the vascular supply of the spinal cord

Answer 4

Single anterior spinal artery
Two posterior spinal arteries

Create anastomotic ring around cord

Question 5

How many pairs of spinal nerves are there?

Answer 5

31 pairs

Question 6

Which spinal segments include the lateral horn?

Answer 6

T1-L2/3

Question 7

What are the motor tracts?

Answer 7

Lateral corticospinal
Anterior corticospinal

Question 8

What are the sensory tracts?

Answer 8

Anterolateral (Spinothalamic)
Dorsal Column

Question 9

Describe the lateral corticospinal tract

Answer 9

motor tract that crosses at level of nerve root
responsible for voluntary movement

Question 10

Describe the anterior corticospinal tract

Answer 10

motor tract that DOES NOT CROSS
responsible for movement of axial muscles

Question 11

Describe the spinothalamic tract

Answer 11

sensory tract that crosses at level
responsible for pain, temp, and crude touch

Anterolateral tract

Question 12

Describe the dorsal column

Answer 12

sensory tract that crosses at pyramidal decussation
responsible for proprioception, vibration and deep touch

Question 13

What are the most common sites of spinal cord injury?

Answer 13

C1-2
C4-6
T12-L1

because these segments are more mobile = less mobility

Question 14

Why are thoracic injuries more likely to be complete injuries?

Answer 14

The ribs offer protection so injury to this area tends to be from knife wound or gunshot wound and if it can get to cord it is more likely to be complete.

MVA and falls are also potential injuries

Question 15

What is the definition of a complete injury?

Answer 15

absence of sensory and motor function at and below level of injury and S4-5

Question 16

What is primary damage to SC?

Answer 16

structural damage and trauma directly to spinal cord

Question 17

What is secondary damage to SC?

Answer 17

pathophysiological cascade of ischemia, edema and other biochemical events

tends to be longer lasting than primary

Question 18

Types of primary damage

Answer 18

concussion
contusion
laceration/maceration

Question 19

Types of secondary damage

Answer 19

ischemia
edema
disruption of ion concentrations
necrosis of spinal cord

Question 20

What are the main causes of ischemia?

Answer 20

trauma to blood vessels
vasospasm
disruption of the venous system
metabolic disturbances and elevated BP due to edema

Question 21

What will ischemia continue to cause?

Answer 21

reduction of circulation
high presence of vasoconstrictive substances in the area-vasospasms
loss of normal auto-regulatory response

Question 22

What is a prominent feature in secondary damage?

Answer 22

Ischemia

Question 23

Where does ischemia appear first?

Answer 23

grey matter

Question 24

What is one of the most important contributors to secondary tissue destruction after SCI?

Answer 24

concentration of calcium

Question 25

What is the end result of ion distribution?

Answer 25

demyelination edema membrane destruction cell death permanent neuro deficits

Question 26

What is Wallerian degeneration?

Answer 26

It causes changes in the white matter ascending posterior tract descending corticospinal tracts

Question 27

What is spinal shock?

Answer 27

nervous system protects itself and turns off all non essential functions below level of lesion

Question 28

In what order does function return after spinal shock?

Answer 28

1. reflexes 2. spasticity 3.sensorimotor

Question 29

What is the amount of neurological return based on?

Answer 29

amount of spinal cord that is still connected to the cortex by surviving, functioning neurons plasticity

Question 30

How long does it take for neurological return to occur after injury?

Answer 30

Most rapid return- 3-6 months Can be up to 3-5 years

Question 31

What is the ASIA Impairment Scale?

Answer 31

standardized tool used to classify motor and sensory impairments secondary to SCI

Question 32

Pros and cons of ASIA

Answer 32

Pro- gives baseline impairments Con- glutes and abdominals not included

Question 33

What is the designation for a complete injury?

Answer 33

ASIA A

Question 34

What determines the level of an injury for motor function?

Answer 34

most caudal level that has 3/5 strength BILATERALLY

Question 35

What are the characteristics of an ASIA B injury?

Answer 35

incomplete injury cannot have motor function more than 3 levels below the lesion can have full sensory return

Question 36

What is Brown Sequard Syndrome?

Answer 36

partial hemi-section of cord asymmetrical pattern of loss -ipsilateral: weakness and loss of proprioception and vibration -contralateral: loss of pain and temp

Question 37

What is anterior cord syndrome?

Answer 37

associated with flexion injuries bilateral loss of motor, pain and temp

Question 38

What is central cord syndrome?

Answer 38

common with extension injuries and older people (typically with stenosis) loss of UE motor function, incomplete loss of trunk motor may spare sacral motor and sensory

Question 39

What is cauda equina syndrome?

Answer 39

Incomplete in nature Commonly: flaccid paralysis of LE, areflexive bowel and bladder loss of sensation in saddle area

Question 40

What is conus medullaris?

Answer 40

results from damage to sacral cord and lumbar nerve roots flaccid paralysis/low tone of LE (leads to muscle atrophy) Areflexive bowel and bladder may retain sacral reflexes

Question 41

What is spasticity?

Answer 41

velocity dependent increase and muscle tone in response to passive movement

Question 42

What are possible causes of elevated muscle tone?

Answer 42

loss of inhibition from higher centers loss of afferent input from limb loading, sprouting of new synaptic terminals below the lesion and hypersensitivity of neurons caudal to lesion

Question 43

What are expected DTR with elevated tone?

Answer 43

increased reflexes clonus present

Question 44

When would you expect to see flaccidity?

Answer 44

typically more caudal lesions (cuada equina and conus medullaris) could occur with higher lesions if damage is to anterior horn cells or nerve roots

Question 45

Expected DTR with flaccidity?

Answer 45

diminished

Question 46

What is autonomic dysreflexia?

Answer 46

"autonomic hyperreflexia" cluster of manifestations that can occur any time after spinal shock resolves **Sudden increase in BP** bradycardia pounding headache profuse sweating above lesion

Question 47

Which patients are likely to get autonomic dysreflexia?

Answer 47

pts with lesions at T6 and above more common with pts with quadraplegia

Question 48

Why is autonomic dysreflexia considered a medical emergency?

Answer 48

hypertension is potentially life threatening

Question 49

What are common causes of autonomic dysreflexia?

Answer 49

bladder distension UTI pressure ulcer

Question 50

What is pathology of autonomic dysreflexia?

Answer 50

imbalanced sympathetic discharge disconnection between brain and sympathetic neurons in the thoracolumbar spine loss of descending inhibition from the medulla sprouting of new synaptic terminals caudal to lesion hypersensitivity of synaptic neurons

Question 51

What are the symptoms of autonomic dysreflexia that pts will report to you?

Answer 51

pounding headache goosebumps (piloerection) sweating above the lesion

Question 52

What is the treatment for autonomic dysreflexia?

Answer 52

quickly remove stimuli catheter may be kinked or pressure ulcer present

Question 53

What are skeletal changes that may occur for SCI pts?

Answer 53

heterotopic ossification - bone forms in odd places (quads or around hip joint) scoliosis osteoporosis

Question 54

What is the risk for higher level lesions?

Answer 54

higher the lesion the higher risk for secondary infections adn higher mortality rate