SCI Part 3 Flashcards
brown-sequard syndrome
most common and best prognosis
hemisection from GSW or stab
loss begins several dermatomes below bcs lat spinothalamic ascend 2-4 segments before same side crossing
brown-sequard syndrome ssx
lat corticopsinal
- ipsi sensory loss
dorsal column
- ipsi loss of motor, proprioception and vibration
spinothalamic
- lost of pain and temp on contra
anterior cord syndrome
shaken baby, down syndrome or laxed ligaments
flexion injury c fracture or discloc tas cervical disc protrusion
require longer in patient - most poor prog
anterior cord syndrome ssx
spinothalamic
- loss of pain and temp
corticospinal
- loss of motor function
intact pos and vibration sense since post spinal arteries still intact
central cord syndrome
UE more affected
50/50 recovery
fall from height level
gymnastics
hangman fracture
central cord syndrome ssx
motor UE - cervical tracts more
motor LE - lumbar and sacral tracts more peripheral
variable sensory deficit
intact sacral tracts - sexual, bowel, bladder
recovers to ambu
distal UE weakness may not be recovered
dorsal column or posterior cord syndrome
easiest to treat
compression of post spinal artery - tumor or infarc
dorsal column or posterior cord syndrome ssx
loss of proprioception and vibration (B)
cauda equina injuries
fracture dislocation at L1
CE lesion are like PNI - same potential to regenerate
cauda equina injuries ssx
UMNL and LMNL
flaccidity
areflexia
loss of bowel and bladder
exp how spinal shock is a complication of SCI
areflexia for 24 hrs after SCI
absence of all reflex and impaired autonomic regulation (hypotension)
gradual return: 1-3 days after
inc hyperreflexia: 1-4 wks after
final hyperreflexia: 1-6 mo after
exp how motor and sensory impairment is a condition of SCI
clinical pres depend on level and completeness
rubrospinal and corticospinal affected
exp how autonomic dysreflexia is a complication of SCI
life threatening - occurs in lesions above T6 and chronic stage of complete SCI
can be caused by blocked catheter
ssx of autonomic dysreflexia
HTN
bradycardia
HA
sweating
spasticity
vasoconstriction below
vasodilation above
what is crede’s maneuver
pressure on abdomen to empty bladder
exp how impaired temp control is a complication of SCI
hyperthermia - vasoconstriction below level
hypothermia - vasodilation above level
hypothalamus can no longer control below level
seen in cervical level and complete SCI
exp how impaired CV is a complication of SCI
SCI above T6 - common orthostatic hypotension
- do ankle pumps
rostral SCI: loss of SY connection bet heart and brain but PSY is intact
- bradycardia and dilation below level
SCI below or within thoracolumbar SY output
- reduced exercise tolerance
- lower SV and CO
exp how spastic hypertonia impairment is a condition of SCI
MC in cervical level injuries - UMNL
imbalance of excitation and inhibition
emerges below level of lesion after spinal shock evolves
neglect of this will inc spasticity = autonomic dysreflexia
gradual inc in hypertonia in _____ and plateau in ______
gradual inc - 1st 6 mo.
plateau - 1 yr p
exp how pulmonary impairment is a condition of SCI
C1-2: phrenic nerve injury and spontaneous respiration is lost
C5-8: fully innervated diaphragm pa
weak or absent respi muscles = greater risk of pneumonia
paralysis of scalenes and intercostal = paradoxical breathing pattern
exp how bladder dysfunction is a condition of SCI
hyper reflexic/spastic bladder: UMN
- cause UTI bcs di ma excrete
flaccid/areflexic bladder: LMN
crede’s maneuver can help
exp how bowel dysfunction is a condition of SCI
hyper reflexic/spastic: lesion above S2
flaccid/areflexic: S2-S4 or cauda equina lesion
_____ is done 3 mo. after spinal shock
urodynamic testing
sexual dysfunction in males
damage above S2-4: UMNL
- spastic penis: alw erected and hard to ejaculate
LMLN
- can ejaculate but problem in erection
2 types of erections
reflexogenic: physical stim
psychogenic: cognitive lang and common is SCi nakaka orgasm
sexual dysfunction in females
UMNL:
- (+) reflexogenic but no psychogenic
LMNL
- interupted menstrual cycles of 4-5 mo. p
- less likely to achieve orgasm
3 most common 2° complications 1 yr p injury
pneumonia ulcers
pneumonia
DVT
discuss pressure ulcers
MC
complete SCI: sacrum, heels and ischium
can become necrotic
discuss DVT
MC in acute stage d/t immob of LE
(+) homan’s test
can result to embolism/stroke
common in (R) LE
discuss nociceptive pain in SCI
overuse or poor posture in shoulder, wrist and elbow
discuss neuropathic pain in SCI
below, at or above level of injury
injury to central or peripheral nervous system
discuss heterotrophic ossification in SCI
care should be taken in PROM
MC in hip and knee
discuss osteoporosis in SCI
rapid bone mineral loss 4-6 mo. p injury
no WB and muscle action
common in LE, females
baka may hidden fractures
