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SCI Flashcards

1
Q

33 vertebrae, how many in each section

A

7 Cervical
12 Thoracic
5 Lumbar
5 Sacrum (fused)
4 Coccyx (fused)

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2
Q

31 pairs of spinal nerves, how many in each section

A

8 Cervical (C1-C8)
12 Thoracic (T1-T12)
5 Lumbar (L1-L5)
5 Sacral (S1-S5)
1 Coccygeal

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3
Q

what makes up the spinal cord

A

33 vertebrae
31 pairs of spinal nerves
conus medullaris
cauda equina

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4
Q

dorsal horn

A

sensory
ascending neurons

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5
Q

ventral horn

A

motor
synapses with peripheral nerve

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6
Q

lateral horn

A

ANS
specifically fight or flight

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7
Q

is there more white or gray matter as you move caudal to cranial

A

WHITE

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8
Q

is there more white or gray matter as you move cranial to caudal

A

GRAY

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9
Q

dorsal column– medial lemniscus

A

(Conscious) proprioception, vibration, light and discriminative touch
Second order neurons cross in caudal medulla in internal arcuate fibers

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10
Q

anterolateral pathways

A

Pain, temperature, crude touch
Second order neurons cross at level of spinal cord through anterior commissure

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11
Q

spinocerebellar pathways

A

Unconscious proprioception from trunk and limbs
Ascends ipsi and contralaterally
Terminates in ipsilateral cerebellum

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12
Q

lateral corticospinal tract
function and where it crosses

A

Function: Volitional movement of contralateral limbs
Cross at the pyramidal decussation and descend contralaterally

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13
Q

anterior corticospinal tract
function

A

Function: Control of bilateral axial and girdle muscles
Descend ipsilaterally until level of spinal cord, at which point splits into bilateral innervation

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14
Q

rubrospinal tract
originates, crosses, and function

A

Originates in Red Nucleus, crosses in midbrain, and descends contralaterally
Assists LCST with descending drive for movement of contralateral limbs (flexors)

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15
Q

vestibulospinal tracts
medial and lateral

A

Medial VST: Originates in rostral medulla, descending bilaterally to cervical region to coantrol positioning of head and neck
Lateral VST: Originates in pons, descends ipsilaterally down spinal cord to aide in truncal control and balance

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16
Q

reticulospinal tract
originates and function

A

Originates in both pontine and medullar RF and descends ipsilaterally
Aids in posture and gait-related movements

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17
Q

tectospinal tract
originates, crosses, and function

A

Originates in superior colliculus, crosses in midbrain and descends contralaterally to upper cervical cord
Assists with coordination of head and eye movements

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18
Q

sympathetic nervous system

A

Fight or Flight
Pupil dilation
Bronchodilation
Cardiac acceleration
Digestive Inhibition
Piloerection
Systemic vasoconstriction

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19
Q

parasympathetic nervous system

A

Rest and Digest
Pupil constriction
Bronchoconstriction
Cardiac deceleration
Digestion stimulation

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20
Q

traumatic SCI MOI

A

MVA, GSW, jumps and falls, diving

Flexion (likely from a car crash)
Flexion + rotation
Extension + rotation
Vertical compression (landing feet first or diving)
Penetration
Hyperextension (falls; more common in c-spine)

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21
Q

non-traumatic SCI MOI

A

Disc prolapse, vascular insult, infections
Often have a worse prognosis

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22
Q

traumatic cervical spine injury
most common at

A

C4 - C7 most frequently involved areas of injury
C5 and C7 most common

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23
Q

traumatic cervical spine injury
most common MOI and other

A

Flexion + rotation

Vertical loading
Extension + rotation
Lateral flexion
Hyperextension

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24
Q

traumatic thoracic injury
most common site

A

T12-L1 junction

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25
traumatic thoracic injury most common MOI
Flexion or vertical compression
26
why are you less likely to be injured from traumatic thoracic injuries
Rib cage and higher stability as compared to cervical region
27
traumatic lumbar SCI MOI
flexion
28
traumatic lumbar SCI most common location
L1
29
tetraplegic
Injury to the cervical spinal cord (C1-C8) Involvement of all 4 extremities and trunk
30
paraplegic
Injury to thoracic or lumbar regions of spinal cord (T1 down) Involves BLEs and trunk (chest down)
31
complete SCI
Absence of sensory and motor function below lesion level More severe presentation of SCI – worse prognosis Can have Zones of Partial Presentation (ZPP)
32
zones of partial presentation
Dermatomes and myotomes caudal to the sensory and motor levels that remain partially innervated Movement rarely has functional importance ex: can randomly flex ankle (trickling of ascending/descending capabilities)
33
incomplete SCI
Involves partial preservation of sensory and motor functions below the lesion level Better prognosis than complete SCI due to preserved axon function Incomplete SCIs occur more frequently than complete
34
what determines the degree of SCI
ASIA exam
35
most common sites of SCI injury
Cervical (C5 and C7) and thoracolumbar junctures (T12-L1)
36
most frequent type of SCI
incomplete tetraplegia
37
primary goal of SCI management any devices?
stabilize spine to prevent further damage Surgery: Closed or open reduction; spinal canal decompression External support devices Halo Brace, CTLSO, TLSO, LSO
38
methylprednisone on complete vs incomplete SCI
Incomplete: Enhances return of some function below spinal level Complete: increases chances of return of function of the last preserved spinal level
39
what is the window of opportunity for methlyprednisone and what does it do
3-8 hours post injury Stabilizes cell membranes Decreases inflammation Increases nerve impulse generation Improves blood flow to damaged area
40
sequelae of SCI
ischemia edema demyelination and necrosis of axons
41
complications of SCI
spinal shock autonomic dysreflexia pressure ulcers postural hypotension pain spasticity contractures hetertopic ossification edema DVT osteoporosis and renal calculi respiratory compromise bladder and bowel dysfunction sexual dysfunction
42
spinal shock
Temporary phenomenon with injuries T6 (ANS) and above
43
initial response to spinal shock
↑ ↑ BP → ↓ BP, HR, hypothermia, venous stasis
44
when does spinal shock resolve and what returns first
Usually resolves within 24 hours to several days of the injury 1st thing to typically return: sacral/anal reflexes
45
autonomic dysreflexia
Over-activity of the autonomic nervous system with damage to T6 or above
46
autonomic dysreflexia cause
irritating stimulus introduced to body below level of spinal cord injury Most common cause: FULL BLADDER Other causes: full bowel, wounds/pressure sores, burns, ingrown toenails, kinked clothing/catheter, foreign object (rock) pressing against skin
47
symptoms of autonomic dysreflexia
Pounding HA (due to ↑ ↑ BP), goosebumps, sweating above level of injury, BRADYcardia, skin blotching
48
interventions for autonomic dysreflexia
If the patient is lying down, sit them up immediately If already in sitting, remain in sitting (DO NOT LIE DOWN), perform pressure relief Check catheter Check clothing Check skin ***Initiate emergency response if not resolved within 10 min***
49
sequelae of autonomic dysrefelxia
Convulsions, LOC, **death**
50
cause of impaired thermoregulation
Due to loss of sympathetic output Damage to T6 or above Body’s ability to control blood vessel responses that conserve or dissipate heat is lost Ability to sweat & shiver are lost At risk of hypothermia due to peripheral vasodilation. Later at risk of hyperthermia due to lack of sweat gland control. Higher level injuries → greater disturbances in temperature control
51
s/sx of hyperthermia
skin feels hot and appears flushed, feeling weak, dizziness, HA, visual disturbances, nausea, tachycardia, weak or irregular HR
52
s/sx of hypothermia
shivering, exhaustion/drowsiness, confusion, slurred speech,
53
what level lesion is spasticity most common
cervical
54
pulmonary dysfunction
“C3, C4, C5 – Keeps the patient alive” → diaphragm Below T10 = normal ventilatory and respiratory function
55
bladder dysfunction above conus medullaris/sacral segments
Spastic/hypereflexic bladder Voiding is involuntary and incomplete
56
management of bladder dysfunction
External collection devices (catheter) Intermittent catheterizations Medication Surgery Suprapubic catheter Bladder augmentation
57
what is the the 2nd most common cause of autonomic dysreflexia
bowel dysfunction
58
management of bowel dysfunction
Reflex Bowel Programs: Digital Stim Programs Bowel Suppositories
59
significant health problems related to bowel management
Rectal prolapse, hemorrhoids, abdominal pain and bloating
60
Level of SCI determines type of dysfunction above vs below
Above S2: spastic/reflex bowel Excrement is involuntary and incomplete S2-S4: flaccid/areflexive bowel Bowel overfills and over-distend
61
Symptoms of Bladder and Bowel Dysfunction
Fever Chills Nausea HA Increased spasticity Autonomic dysreflexia Dark or bloody urine
62
sexual dysfunction males vs females
Males: directly related to level and completeness of injury Erectile capacity spared with UMN lesions, but fertility can be impacted Females: menstruation and fertility more likely to be spared Pregnancy is often considered high risk if SCI present (likely need C-section)
63
strategies for BP instability
TED stockings, abdominal binder*, ace wraps, monitoring fluid intake
64
common cardiovascular dysfunction for T6 and up
persistent bradycardia, excessive peripheral vascular dilation
65
neuropathic pain
Poorly localized c/o numbness, tingling, burning, shooting, and aching pain & visceral discomfort below level of injury Can be exaggerated by noxious stimuli, UTI, spasticity, bowel impaction, & cigarette smoking
66
orthopedic pain common sites
shoulder overuse injuries, low back
67
common causes of pain post-SCI
irritation & damage to neural elements, mechanical trauma, surgical interventions, poor handling & positioning
68
management of osteoporosis and renal calculi
Preventative Early mobilization Therapeutic standing Administration of calcium supplements Good dietary management
69
Decreased weight bearing may lead to
demineralization of bones which can then lead to vertebral compression fractures and other fractures.
70
causes of anterior cord syndrome
Damage to cord itself, damage to Anterior Spinal Artery, or both Common cause: flexion injuries, burst fractures
71
anterior cord syndrome= loss of motor function and _____
pain/temp below level of injury bilaterally
72
what tract stays intact with anterior cord syndrome
medial lemniscus
73
central cord syndrome results from
damage to central aspect of spinal cord Almost exclusively a cervical injury
74
central cord syndrome common occurs in the elderly due to ______ in youbger population due to ____
Typically, due to extension injury Often results from relatively minor trauma, often without vertebral trauma Younger population: flexion + compression +vertebral trauma, herniated disc
75
central cord syndrome extremity involvement
UE>LE Sparing sacral sensation, may have sparing of sacral motor
76
brown sequard syndrome results from damage to causes?
one side of cord Hemi-section or incomplete injury cause: knife wound or GSW
77
brown sequard syndrome results in
IPSILATERAL motor and dorsal column symptoms and CONTRALATERAL anterolateral pathway symptoms Ipsilateral spasticity common below level of lesion IPSI– BECAUSE TRACT HAS NOT CROSSED (not until brainstem) CONTRA– BECAUSE ALS IMMEDIATELY CROSSES OVER in spinal cord (such as reduction in pain, temperature, crude touch)
78
posterior cord syndrome results from
compression by disc or tumor, PSA infarct, or vitamin B12 deficiency extremely rare
79
posterior cord syndrome what is lost and what is preserved
Dorsal column lost bilaterally below level of lesion Motor and pain/temp preserved
80
anterior cord prognosis
extremely poor for: Bowel and bladder function Hand function Ambulation 10-20% chance of motor recovery
81
central cord prognosis
Most people will regain some level of ambulatory function This becomes more disproportionate with older patients (90% versus 41%) >50% will recover bowel and bladder control Intrinsic hand function last to return
82
positive prognostic factors for central cord syndrome
Good hand function, Evidence of early motor recovery Young age Absence of spasticity, Pre-injury employment, Absence of LE neurologic motor impairment at rehab admission
83
Brown-Séquard Syndrome prognosis
generally very good Nearly all patients will attain some level of ambulatory function 80% regain hand function 100% regain bladder control, 80% bowel control
84
conus medullaris syndrome damage to cause?
Damage to sacral cord and lumbar nerve roots Common cause: trauma, tumors, infections, stenosis
85
conus medullaris syndrome symptoms
Sudden onset of UMN and LMN symptoms Symmetrical saddle anesthesia – more localized perianal Symmetrical weakness/flaccidity Can see hypertonicity Distal LE (ankle) areflexia May see intact sacral reflexes Sexual dysfunction Mild low back pain with potential mild radicular symptoms, more pain noted in perianal region Bowel & bladder dysfunction: typically urinary retention and atonic anal sphincter
86
conus medullaris syndrome tx
surgical decompression
87
cauda equina syndrome where does injury occur
below L1 to lumbosacral roots of peripheral nerves → LMN injury Cord spared
88
cauda equina syndrome causes
lumbar burst fx or herniated disc Can be acute or chronic presentation Damage to nerve roots is highly variable, incomplete lesions common
89
cauda equina syndrome symptoms
(can be gradual onset or acute): Common triad: Asymmetrical saddle anesthesia, bowel and/or bladder dysfunction, asymmetrical LE weakness Variable sensory loss: partial vs complete loss Flaccid paralysis, areflexia (including loss of sacral reflexes) Flaccid paralysis of bowel and bladder Severe low back pain, often with severe radicular pain
90
cauda equina tx
surgical decompression
91
cauda equina prognosis
PNS injury → potential for nerve regeneration! However, regeneration often incomplete Tends to plateau after 1 year Prognosis: Bladder outcomes worsen the longer the cauda equina is compressed Prognosis improves when surgery occurs within 48 hours of initial presentation Due to potential for regeneration, more favorable prognosis for functional recovery compared to UMN SCI Syndromes
92
conus medullaris prognosis
Similar prognostic indicators, but since UMN involvement, prognosis less favorable than CES 10% regain function

NEURO 2 (6 decks)

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