SCI Part 3

Question 1

brown-sequard syndrome

Answer 1

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

Question 2

brown-sequard syndrome ssx

Answer 2

lat corticopsinal
- ipsi sensory loss

dorsal column
- ipsi loss of motor, proprioception and vibration

spinothalamic
- lost of pain and temp on contra

Question 3

anterior cord syndrome

Answer 3

shaken baby, down syndrome or laxed ligaments

flexion injury c fracture or discloc tas cervical disc protrusion

require longer in patient - most poor prog

Question 4

anterior cord syndrome ssx

Answer 4

spinothalamic
- loss of pain and temp

corticospinal
- loss of motor function

intact pos and vibration sense since post spinal arteries still intact

Question 5

central cord syndrome

Answer 5

UE more affected

50/50 recovery

fall from height level
gymnastics
hangman fracture

Question 6

central cord syndrome ssx

Answer 6

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

Question 7

dorsal column or posterior cord syndrome

Answer 7

easiest to treat

compression of post spinal artery - tumor or infarc

Question 8

dorsal column or posterior cord syndrome ssx

Answer 8

loss of proprioception and vibration (B)

Question 9

cauda equina injuries

Answer 9

fracture dislocation at L1

CE lesion are like PNI - same potential to regenerate

Question 10

cauda equina injuries ssx

Answer 10

UMNL and LMNL

flaccidity
areflexia
loss of bowel and bladder

Question 11

exp how spinal shock is a complication of SCI

Answer 11

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

Question 12

exp how motor and sensory impairment is a condition of SCI

Answer 12

clinical pres depend on level and completeness

rubrospinal and corticospinal affected

Question 13

exp how autonomic dysreflexia is a complication of SCI

Answer 13

life threatening - occurs in lesions above T6 and chronic stage of complete SCI

can be caused by blocked catheter

Question 14

ssx of autonomic dysreflexia

Answer 14

HTN

bradycardia

HA

sweating

spasticity

vasoconstriction below

vasodilation above

Question 15

what is crede’s maneuver

Answer 15

pressure on abdomen to empty bladder

Question 16

exp how impaired temp control is a complication of SCI

Answer 16

hyperthermia - vasoconstriction below level

hypothermia - vasodilation above level

hypothalamus can no longer control below level

seen in cervical level and complete SCI

Question 17

exp how impaired CV is a complication of SCI

Answer 17

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

Question 18

exp how spastic hypertonia impairment is a condition of SCI

Answer 18

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

Question 19

gradual inc in hypertonia in _____ and plateau in ______

Answer 19

gradual inc - 1st 6 mo.

plateau - 1 yr p

Question 20

exp how pulmonary impairment is a condition of SCI

Answer 20

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

Question 21

exp how bladder dysfunction is a condition of SCI

Answer 21

hyper reflexic/spastic bladder: UMN
- cause UTI bcs di ma excrete

flaccid/areflexic bladder: LMN

crede’s maneuver can help

Question 22

exp how bowel dysfunction is a condition of SCI

Answer 22

hyper reflexic/spastic: lesion above S2

flaccid/areflexic: S2-S4 or cauda equina lesion

Question 23

_____ is done 3 mo. after spinal shock

Answer 23

urodynamic testing

Question 24

sexual dysfunction in males

Answer 24

damage above S2-4: UMNL
- spastic penis: alw erected and hard to ejaculate

LMLN
- can ejaculate but problem in erection

Question 25

2 types of erections

Answer 25

reflexogenic: physical stim

psychogenic: cognitive lang and common is SCi nakaka orgasm

Question 26

sexual dysfunction in females

Answer 26

UMNL:
- (+) reflexogenic but no psychogenic

LMNL
- interupted menstrual cycles of 4-5 mo. p
- less likely to achieve orgasm

Question 27

3 most common 2° complications 1 yr p injury

Answer 27

pneumonia ulcers
pneumonia
DVT

Question 28

discuss pressure ulcers

Answer 28

MC

complete SCI: sacrum, heels and ischium

can become necrotic

Question 29

discuss DVT

Answer 29

MC in acute stage d/t immob of LE

(+) homan’s test

can result to embolism/stroke

common in (R) LE

Question 30

discuss nociceptive pain in SCI

Answer 30

overuse or poor posture in shoulder, wrist and elbow

Question 31

discuss neuropathic pain in SCI

Answer 31

below, at or above level of injury

injury to central or peripheral nervous system

Question 32

discuss heterotrophic ossification in SCI

Answer 32

care should be taken in PROM

MC in hip and knee

Question 33

discuss osteoporosis in SCI

Answer 33

rapid bone mineral loss 4-6 mo. p injury

no WB and muscle action

common in LE, females

baka may hidden fractures