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Neuro Mosier > SCI > Flashcards

SCI Flashcards

1
Q

Damage to the spinal column may occur without injury to the cord, or it can cause SCI through which 3 mechanisms?

A
  • compression
  • hemorrhage
  • traumatic vasospasm
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2
Q

Compression, hemorrhage or traumatic vasospasm to the cord may result in _______________________.

A

Ischemia/infarction

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3
Q

What is traumatic SCI frequently associated with?

A
  • systemic hypotension

- reduced spinal cord perfusion pressure

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4
Q

T/F Systemic hypotension may contribute to secondary ischemic neurologic injury and should be avoided.

A

True

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5
Q

What two things can cause hypotension that exacerbates secondary injury to the spinal cord?

A

Hemorrhage and neurogenic shock

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6
Q

When does secondary SCI peak at?

A

4-6 days

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7
Q

During the acute phase of SCI what happens concerning sympathetic innervation?

A

Systemic vasodilation from loss of sympathetic tones occurs in increasing severity with ascending levels of SCI above L2, leading to hypotension

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8
Q

During the acute phase of SCI, what complicates things with injuries above T6?

A

Bradycardia d/t compromise of the sympathetic cardiac accelerator fibers

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9
Q

What happens during neurogenic shock?

A
  • diminished effect of sympathetic pathways
  • loss of vasomotor tone and diminished sympathetic innervation of the heart
  • vasodilation of blood vessels (visceral and lower extremity)
  • pooling of blood leading to hypotension and bradycardia
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10
Q

What is the treatment for neurogenic shock?

A

fluid resuscitation
+/- vasopressors
+/- atropine

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11
Q

What happens during spinal shock?

A 
Temporary features of lower motor neuron lesions:
- flaccidity
- paralysis
- loss of reflexes
—> with resolution within 24 hours **
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12
Q

What is the clinical marker of spinal shock?

A

Bulbocavernous reflex

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13
Q

When is the prognosis based on neurologic exams most reliable for spinal shock?

A

72 hours - 1 week following trauma

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14
Q

What is autonomic hyperreflexia?

A

A chronic neurologic disorder that occurs in association with resolution of spinal shock and a return of spinal cord reflexes

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15
Q

During autonomic hyperreflexia what initiates afferent impulses that are transmitted to the spinal cord below the level of spinal cord transection?

A

Cutaneous or visceral stimulation (such as distention of the urinary bladder or rectum)

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16
Q

During autonomic hyperreflexia, cutaneous or visceral stimulation elicits a reflex sympathetic response that results in:

A

Intense generalized vasoconstriction and hypertension

17
Q

During autonomic hyperreflexia, what is a secondary occurrence to HTN?

A

Bradycardia d/t activation of baroreceptor reflexes

18
Q

The incidence of autonomic hyperreflexia during general anesthesia depends on:

A

The level of spinal cord transection

19
Q

Approximately _____ of patients with spinal cord transection above ____________________ will exhibit autonomic hyperreflexia during general anesthesia.

A

85%

The T6 dermatome

20
Q

It is difficult to illicit autonomic hyperreflexia in patients with spinal cord transection below the ______ dermatome.

A

T10

21
Q

How do you treat autonomic hyperreflexia?

A

PREVENTION!
- neuraxial block, either SAB or Epidural

Direct acting vasodilators

  • nitroprusside
  • nitroglycerin
22
Q

What takes place during upper motor neuron injury?

A
  • spastic paralysis
  • NOT associated with muscle atrophy
  • hyperreflexia
23
Q

What is an example of an upper motor neuron injury?

A

Cerebral palsy

24
Q

What takes place with lower motor neuron injury (peripheral nerves)?

A
  • flaccid paralysis
  • associated with muscle atrophy
  • hyporeflexia
25
Q

What happens when motor pathways in the lumbar area are injured (L1-S5)?

A
  • Injury to L2 and above causes spastic paralysis of the lower extremities
  • injury causes bowel, bladder and sexual dysfunction
26
Q

What happens when motor pathways of the thoracic area are injured (T1-T12)?

A
  • Injury causes the same deficits as lumbar injury

- T9 - T12 causes loss of trunk and abdominal muscle control

27
Q

What is unique to injury of the thoracic area above T6?

A
  • autonomic dysreflexia
  • neurogenic shock: loss of vascular muscle tone
  • T1-T4 are the cardiac accelerator fibers
  • can cause disruption of body temperature regulation
28
Q

What happens during motor pathway injury to the cervical area (C1-C8)?

A

Injury causes same deficits as thoracic injury

  • C3-C5 innervate the diaphragm
  • C1-C4 injury causes quadriplegia and need for mechanical ventilation
  • C5 and above, pt will have difficulty clearing secretions

Neuro Mosier (3 decks)

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