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Pathophysiology > SCI > Flashcards

SCI Flashcards

1
Q

Plegia

A

Complete lesion

No strength

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2
Q

Paresis

A

some muscle strength is preserved

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3
Q

What are the layers of the meninges?

A

dura mater
arachnoid mater
pia mater

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4
Q

Describe the vascular supply of the spinal cord

A

Single anterior spinal artery
Two posterior spinal arteries

Create anastomotic ring around cord

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5
Q

How many pairs of spinal nerves are there?

A

31 pairs

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6
Q

Which spinal segments include the lateral horn?

A

T1-L2/3

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7
Q

What are the motor tracts?

A

Lateral corticospinal
Anterior corticospinal

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8
Q

What are the sensory tracts?

A

Anterolateral (Spinothalamic)
Dorsal Column

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9
Q

Describe the lateral corticospinal tract

A

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

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10
Q

Describe the anterior corticospinal tract

A

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

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11
Q

Describe the spinothalamic tract

A

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

Anterolateral tract

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12
Q

Describe the dorsal column

A

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

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13
Q

What are the most common sites of spinal cord injury?

A

C1-2
C4-6
T12-L1

because these segments are more mobile = less mobility

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14
Q

Why are thoracic injuries more likely to be complete injuries?

A

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

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15
Q

What is the definition of a complete injury?

A

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

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16
Q

What is primary damage to SC?

A

structural damage and trauma directly to spinal cord

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17
Q

What is secondary damage to SC?

A

pathophysiological cascade of ischemia, edema and other biochemical events

tends to be longer lasting than primary

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18
Q

Types of primary damage

A

concussion
contusion
laceration/maceration

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19
Q

Types of secondary damage

A

ischemia
edema
disruption of ion concentrations
necrosis of spinal cord

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20
Q

What are the main causes of ischemia?

A

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

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21
Q

What will ischemia continue to cause?

A

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

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22
Q

What is a prominent feature in secondary damage?

A

Ischemia

23
Q

Where does ischemia appear first?

A

grey matter

24
Q

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

A

concentration of calcium

25
Q

What is the end result of ion distribution?

A

demyelination
edema
membrane destruction
cell death
permanent neuro deficits

26
Q

What is Wallerian degeneration?

A

It causes changes in the white matter

ascending posterior tract
descending corticospinal tracts

27
Q

What is spinal shock?

A

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

28
Q

In what order does function return after spinal shock?

A
  1. reflexes
  2. spasticity
    3.sensorimotor
29
Q

What is the amount of neurological return based on?

A

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

plasticity

30
Q

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

A

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

31
Q

What is the ASIA Impairment Scale?

A

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

32
Q

Pros and cons of ASIA

A

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

33
Q

What is the designation for a complete injury?

A

ASIA A

34
Q

What determines the level of an injury for motor function?

A

most caudal level that has 3/5 strength BILATERALLY

35
Q

What are the characteristics of an ASIA B injury?

A

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

36
Q

What is Brown Sequard Syndrome?

A

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

37
Q

What is anterior cord syndrome?

A

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

38
Q

What is central cord syndrome?

A

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

39
Q

What is cauda equina syndrome?

A

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

40
Q

What is conus medullaris?

A

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

41
Q

What is spasticity?

A

velocity dependent increase and muscle tone in response to passive movement

42
Q

What are possible causes of elevated muscle tone?

A

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

43
Q

What are expected DTR with elevated tone?

A

increased reflexes
clonus present

44
Q

When would you expect to see flaccidity?

A

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

45
Q

Expected DTR with flaccidity?

A

diminished

46
Q

What is autonomic dysreflexia?

A

“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

47
Q

Which patients are likely to get autonomic dysreflexia?

A

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

48
Q

Why is autonomic dysreflexia considered a medical emergency?

A

hypertension is potentially life threatening

49
Q

What are common causes of autonomic dysreflexia?

A

bladder distension
UTI
pressure ulcer

50
Q

What is pathology of autonomic dysreflexia?

A

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

51
Q

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

A

pounding headache
goosebumps (piloerection)
sweating above the lesion

52
Q

What is the treatment for autonomic dysreflexia?

A

quickly remove stimuli
catheter may be kinked or pressure ulcer present

53
Q

What are skeletal changes that may occur for SCI pts?

A

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

54
Q

What is the risk for higher level lesions?

A

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

Pathophysiology (10 decks)

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