SCI syndromes Flashcards
what makes an SCI a syndrome?
the cord is injured in some way other than the bilateral way we’d expect due to specific MOI
what is the common MOI for anterior cord syndrome?
flexion injuries and burst fractures> damage to cord, ant spinal artery, or both
what presentation would we expect from anterior cord syndrome?
ML intact! but loss of motor function and pain/temp below level of injury bilat
what is the prevalence of anterior cord syndrome?
3% of traumatic SCIs
what is the common MOI for central cord syndrome? How does it differ between older and younger populations?
almost exclusive cervical injury
elderly: ext injury often w/ spondylosis or stenosis but no vertebral fx
younger: flexion + compression + vertebral fx and herniated disc
what presentation would we expect from central cord syndrome?
UE>LE “upside down SCI”, sparing sacral sensation and maybe motor
what is the prevalence of central cord syndrome?
9% of traumatic SCIs
what is the common MOI for Brown-Sequard Syndrome
knife or GSW> damage to only one side of the cord
what presentation would we expect for Brown-Sequard syndrome?
dysfunction in IPSALAT motor, LT sensation + spasticity, CONTRALAT anterolateral pathways (temp/pain, crude touch)
what is the prevalence of Brown-Sequard syndrome?
1-4% traumatic SCIs
what is the common MOI of posterior cord syndrome
compression by disc or tumor,
PSA infarct
B12 deficiency
what presentation would we expect for posterior cord syndrome?
dorsl column (LT) lost bilat below level but nearly everything else is preserved
what is the prevalence of posterior cord syndrome?
extremely rare (<1% traumatic SCIs)
What are some prognostic expectations associated with central cord syndrome?
most people will regain ambulatory potential (especially younger), about half will regain bladder control, and half may demonstrate return to hand fn (last to come)
what are the positive prognostic factors associated with central cord syndrome?
-young age and pre-injury employment
good hand function,
-absent LE neurologic impairment @ rehab admission
-absent spasticity and evidence of early motor recovery
What are some prognostic expectations associated with Brown-Sequard syndrome?
all regain bladder control
nearly all pts regain some ambulatory function (even by discharge)
80% regain hand function and bowel control
rank the prognosis of anterior, central and brown-sequard syndromes (good>poor)
Brown-Sequard>Central > Anterior
What is the common MOI for conus medullaris syndrome?
trauma/infection/tumors/stenosis> sacral cord + lumbar root damage
what presentation would we expect for conus medullaris syndrome?
UMN+ LMN combo!
-symmetrical saddle anesthesia (esp perianal) and weakness;
-potential for hypertonicity and more distal areflexia
-sexual , urinary/bowel dysfn (secondary to retention and tone)
-MILD LBP + radicular s/s
what is the mandatory treatment option for conus medullaris syndrome?
surgical decompression
What is the common MOI for cauda equina syndrome?
lumbar burst fx or herniated disc> damage (below L1) to LS roots of peripheral n.
what triad presentation might we expect for cauda equina syndrome?
often ASYMMETRICAL saddle anesthesia and LE weekness+ potential bladder dysfn
what non-triad presentation might we expect for cauda equina syndrome?
variable sensory loss, flaccid paralysis and areflexia (including in bowel and bladder) , SEVERE LBP
what are positive prognostic factors associated with cauda equina syndrome?
PNS injury has potential for nerve regeneration-specifically in the first year (incomplete and often plateaus)
-surgery within 48 hrs of initial presentation
What are some prognostic expectations associated with cauda equina syndrome
bladder outcomes worsen with duration of compression
What percent of people with conus medullaris syndrome regain function
10%
How commonly do we see motor recovery in anterior cord syndromes? Is it a full recovery?
there is about a 10-20% chance of motor recovery and these pts usually demonstrate poor power and coordination .
Typically ASIA (not syndromes): How do ASIA results fit into the prognostic indicators for walking after SCI, and what other indicators are available?
ASIA is the #1 prognostic indicator but we also look @ early reflex examination, syndromes, acquired vs traumatic, and age
How does the prognosis for conus medullaris syndrome compare to that of cauda equina syndrome?
they have similar prognostic indicator but CM is is less favorable that CES due to UMN involvement
