SCI Syndromes Flashcards
List SCI Syndromes (5)
- Anterior Cord Syndrome
- Central Cord Syndrome
- Brown-Sequard Syndrome
- Cauda Equina
- Conus Medullaris Syndrome
what is the cause and common MOIs for anterior cord syndrome?
- Causes
- damage to cord itself
- damage to anterior spinal artery
- all of the above
- Common MOI
- flexion injuries
- burst frxs
clinical presentation of anterior cord syndrome
Bilateraly loss of motor function and pain/temp below level of injury
T/F: medial lemniscus tracts are damaged with anterior cord syndrome
FALSE
they remain intact
what is the most common SCI syndrome?
central cord syndrome
9% of all traumatic SCI injuries
what is central cord syndrome? Which one of these does it occur the most in? (cervical, thoracic, lumbar, sacral)
damage to central aspect of spinal cord
occurs almost exclusively as a cervical injury
Central Cord syndrome is more common in what populations/age groups?
- Elderly → prior spondylosis or stenosis
- typically due to extension injury
- often results with relatively minor trauma, often w/o vertebral trauma
- Younger populations → flexion + compression
- +vertebral trauma
- herniated disc
clinical presentation of central cord syndrome
- UE >> LE involvement
- sparing sacral sensation, may have sparing of sacral motor
describe why central structures may be injuried with central cord syndrome
2 different hypotheses:
- severe extension moment crunches center of cord causing more necrosis
- general extension movements involved in injury may result in specific pattern of ischemia, necrosis and edmea that doesn’t travel to the periphery
what is brown-sequard syndrome? Is this common or uncommon?
damage to only one side of the cord
relatively uncommon (1-4% of traumatic SCIs)
what are some potential causes of brown-sequard syndrome?
knife or gunshot wound
resulting in hemi-section or incomplete injury
clinical presentation of brown-sequard syndrome
depends on level of injury but generally:
- ipsilateral motor and dorsal column symptoms
- motor
- touch, proprioception, 2-pt discrimination
- contralateral anterolateral pathway symptoms
- pain and temperature
- ipsilateral spasticity common below level of lesion
how common is posterior cord syndrome?
extremely rare (<1% of traumatic SCIs)
cause of posterior cord syndrome
results from
- compression by disc or tumor
- PSA infarct
- vitamin B12 deficiency
clinical presentation and prognosis for posterior cord syndrome
- dorsal column lost bilaterally below level of lesion
- motor and pain/temp preserved
- prognosis → typically respond well to rehab
Prognosis for anterior cord syndrome
What has a chance of recovery? What is unlikely to recover?
- Extremely poor for
- bowel and bladder function
- hand function
- ambulation
- 10-20% chance of motor recovery
- even with those with some recovery, demo poor power and coordination
Prognosis for central cord syndrome
- Most ppl will regain some level of ambulatory function
- becomes more disproportionate w/older pts (90% vs 41%)
- >50% will recover bowel and bladder control
- Intrinsic hand function last to return
- <50% may demo return of hand function
List postive prognostic factors for central cord syndrome (6)
- good hand function
- evidence of early motor recovery
- young age
- absense of spasiticity
- pre-injury employment
- absence of LE neurologic motor impairment at rehab admission
Prognosis ffor brown-sequard syndrome
- generally very good
- nearly all pts will attain some level of ambulatory function
- 80% regain hand function
- 100% regain bladder control, 80% bowel control
list the general mechansim of each SCI syndrome
- Anterior → flexion or fasculature
- Central → forced hyperextension
- Brown-Sequard → penetrating trauma
brief clinical description of Anterior Cord Syndrome
- complete loss of motor, pain, and temp below injury
- retains proprioception and vibratory sensation
- Prognosis → POOR
brief clinical description of Central Cord Syndrome
- Sensory and motor deficit UE >> LE
- Prognosis → AVERAGE
brief clinical description of Brown-Sequard Syndrome
- Ipsilateral loss of motor, vibration, and proprioception
- Contralateral loss of pain, and temp
- Prognosis → GOOD
what is conus medullaris syndrome?
damage to sacral cord and lumbar nerve roots
common causes of conus medullaris syndrome (4)
- trauma
- tumors
- infections
- stenosis
Conus Medullaris symptoms
- Symmetrical saddle anesthesia - more localized perianal
- Symmetrical weakness/flaccidity
- possible hypertonicity
- Distal LE (ankle) areflexia
- Sexual dysfunction
- Mild LBP w/potential mild radicular symptoms
- more pain noted in perianal region
- Bowel and bladder dysfunction
- typically urinary retention and atonic anal sphincter
T/F: you may see intact sacral reflexes in Conus Medullaris Syndrome
TRUE
Conus Medullaris Syndrome Treatment
surgical decompression
what is cauda equina syndrome?
injury below L1 to lumbosacral roots of peripheral nerves
making this a LMN INJURY
**the spinal cord is spared
common causes of cauda equina syndrome
- lumbar durst frx
- herniated disc
can be acute or chronic presentation
T/F: incomplete lesions in cuada equina syndrome are rare
FALSE
they are common since damage to nerve roots is highly variable
Cauda Equina Symptoms
can be gradual onset or acute
- Common triad
- asymmetrical saddle anesthesia
- bowel and/or bladder dysfunction
- asymmetrical LE weakness
- variable sensory loss
- flaccid paralysis, areflexia
- including loss of sacral reflexes
- flaccid paralysis of bowel and bladder
- severe LBP, often with severe radicular pain
treatment for cauda equina syndrome
surgical decompression
T/F: there may be nerve regeneration with cauda equina syndrome
TRUE
however regeneration is often incomplete
tends to plateau after 1 year
Prognosis for cauda equina syndrome
- 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
Prognosis for conus medullaris syndrome
- similar prognostic indicators as cauda equina but since UMN involvment, the prognosis is less favorable
- 10% regain function
