SCI Flashcards
which part of the SC is more protected d/t its blood supply?
posterior
posterior spinal artery has 2 branches and supplies 1/3 of SC
what part of the spinal cord is damaged in ALS?
anterior horn cells (motor neurons)
Wallerian degeneration
where does the spinothalamic tract cross?
anterior commissure of the SC immediately/1-2 levels above enter
if there is a stroke at the thalamus, where will pain & temp deficits be?
contralateral
where does the DCML cross?
caudal medulla
(internal arcuate fibers)
how will DCML be lost with a lesion at the SC?
ipsilateral
which structure does all sensory integration for the entire body (except face)?
ventral posterior lateral nucleus of thalamus
where does the corticospinal tract cross?
medulla (cervical medullary junction)
pyramids
which spinal levels do the parasympathetic NS?
cervical and sacral
which spinal levels do the sympathetic NS?
T1-L3
what sx are indicative of a SC lesion?
bilateral sx
B/B involvement
leg stiffness
neck or back pain
Lhermitte or Uhthoff
sensory level
tight band sensation across trunk/torso
tight band sensation across trunk/torso could indicate what condition?
transverse myelitis (–> MS)
what is the 2 most common complete SCI?
1 C5
2 C4
what spinal levels lead to quadriplegia?
C1-T2
what spinal levels lead to paraplegia?
T3 and down
what is the ASIA scale?
assesses the level of involvement of a SCI
assesses prognosis
should be done w/i 24-48 hours post SCI
what are the UE motor tests on the ASIA?
C5 elbow flexors
C6 wrist extensors
C7 elbow extensors
C8 finger flexors
T1 finger abductors
what are the LE motor tests on the ASIA?
L2 hip flexors
L3 knee extensors
L4 DF
L5 great toe extensors
S1 PF
what determines if a SCI is complete or not?
if there is voluntary anal contraction = not complete
how is motor testing performed on the ASIA scale?
all done in supine
what are the grades of SCI on the ASIA scale?
A = complete (S4-5 impaired)
B = sensory incomplete (no motor)
C = motor incomplete: <1/2 key mm functions & mm grade < 3
D = motor incomplete: at least 1/2 key mm functions & mm grade ≥ 3
E = normal
sx of spinal shock
immediate flaccidity & loss of sensory and autonomic function BELOW level of lesion
atonic bladder
loss of vasomotor control
how to determine if person is out of spinal shock?
anal wink/reflex returned
autonomic dysreflexia occur in a SCI above ____ level
T5
SCI sx after spinal shock
increased reflexes
spasticity below lesion level
pathological pyramidal reflexes
spastic bladder
paralyzed legs w/ contractures
autonomic dysreflexia (above T5)
which spinal level SCI is dependent with verbal communication?
C1-C3
what is autonomic dysreflexia?
exaggerated sympathetic response to noxious stimuli below lesion (for SCI above T5)
sx of autonomic dysreflexia
hypertension
sweating
flushing
bradycardia
autonomic dysreflexia is usually due to ___ injury of SCI
complete transverse
risk of autonomic dysreflexia is increased after recovery from
spinal shock
T/F: fertility is maintained in both F and M with SCI
F
just F
leading causes of death of SCI pts
sepsis
pneumonia
respiratory failure
when is the highest rate of lowered life expectancy after a SCI?
1st year
what is the most common level for cervical spondylosis?
C5-C6
cervical spondylosis causes ____ below the lesion and ___ at the level of the lesion
below - myopathy
@ - radiculopathy
C spine injury has ___ deficits at the level of the lesion and ____ below
@ - UMN
below - LMN
motor neuron injuries (ex: ALS) has ____ deficits at the level of the lesion and ____ below
@ - LMN
below - UMN
what is a sign of permanent injury to the SC and requires surgery?
cord signal change
what is the most common non-traumatic SCI?
cervical spondylotic myelopathy
sx of cervical spondylotic myelopathy
pain
burning
weakness
numbness
tingling
B/B dysfunction !!
Lhermitte’s phenomenon !!
more fine motor involvement
a positive Hoffman’s sign indicates a lesion where?
C spine
what is the most common level to have a SC met?
thoracic
what is the only SCI treated with steroids?
SC mets
primary tumor sites that go to SC mets
lung
breast
prostate
kidney
thyroid
gut
red flags of epidural abscess
fever
back pain
diabetes
an epidural abscess will be ___ shaped
crescent
subacute combine degeneration is a SC syndrome that involves the _____ and _____ tracts
posterior column and corticospinal
posterolateral column syndrome is usually caused by _____ deficiency
B12
what is the model disease for posterior column syndrome?
neurosyphilis (Tabes dorsalis)
*absent reflexes but preserved strength
hemicord syndrome sx
ipsi UMN weakness below lesion
ipsi LMN weakness at lesion level
ipsi loss of vibration & proprioception
CONTRA loss of pain and temp 1-2 levels below
ipsi nerve root pain
ipsi impaired sweating
NMO can lead to what kind of SCI?
central cord syndrome
Chiari malformation can cause ___ which is a central cavitation of the SC
syringomyelia
where is syringomyelia most common?
C spine
syringomyelia will have a ____ distribution of weakness and reflex loss
cape
*in hands and arms
anterior cord syndrome is usually due to
anterior spinal artery stroke
what tracts are affected with anterior cord syndrome?
CST
STT
conus medullaris & cauda equina syndrome presentation
preserved UE
impaired B/B function
absent reflexes
