SCI syndromes

Question 1

what makes an SCI a syndrome?

Answer 1

the cord is injured in some way other than the bilateral way we’d expect due to specific MOI

Question 2

what is the common MOI for anterior cord syndrome?

Answer 2

flexion injuries and burst fractures> damage to cord, ant spinal artery, or both

Question 3

what presentation would we expect from anterior cord syndrome?

Answer 3

ML intact! but loss of motor function and pain/temp below level of injury bilat

Question 4

what is the prevalence of anterior cord syndrome?

Answer 4

3% of traumatic SCIs

Question 5

what is the common MOI for central cord syndrome? How does it differ between older and younger populations?

Answer 5

almost exclusive cervical injury
elderly: ext injury often w/ spondylosis or stenosis but no vertebral fx
younger: flexion + compression + vertebral fx and herniated disc

Question 6

what presentation would we expect from central cord syndrome?

Answer 6

UE>LE “upside down SCI”, sparing sacral sensation and maybe motor

Question 7

what is the prevalence of central cord syndrome?

Answer 7

9% of traumatic SCIs

Question 8

what is the common MOI for Brown-Sequard Syndrome

Answer 8

knife or GSW> damage to only one side of the cord

Question 9

what presentation would we expect for Brown-Sequard syndrome?

Answer 9

dysfunction in IPSALAT motor, LT sensation + spasticity, CONTRALAT anterolateral pathways (temp/pain, crude touch)

Question 10

what is the prevalence of Brown-Sequard syndrome?

Answer 10

1-4% traumatic SCIs

Question 11

what is the common MOI of posterior cord syndrome

Answer 11

compression by disc or tumor,
PSA infarct
B12 deficiency

Question 12

what presentation would we expect for posterior cord syndrome?

Answer 12

dorsl column (LT) lost bilat below level but nearly everything else is preserved

Question 13

what is the prevalence of posterior cord syndrome?

Answer 13

extremely rare (<1% traumatic SCIs)

Question 14

What are some prognostic expectations associated with central cord syndrome?

Answer 14

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)

Question 15

what are the positive prognostic factors associated with central cord syndrome?

Answer 15

-young age and pre-injury employment
good hand function,
-absent LE neurologic impairment @ rehab admission
-absent spasticity and evidence of early motor recovery

Question 16

What are some prognostic expectations associated with Brown-Sequard syndrome?

Answer 16

all regain bladder control
nearly all pts regain some ambulatory function (even by discharge)
80% regain hand function and bowel control

Question 17

rank the prognosis of anterior, central and brown-sequard syndromes (good>poor)

Answer 17

Brown-Sequard>Central > Anterior

Question 18

What is the common MOI for conus medullaris syndrome?

Answer 18

trauma/infection/tumors/stenosis> sacral cord + lumbar root damage

Question 19

what presentation would we expect for conus medullaris syndrome?

Answer 19

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

Question 20

what is the mandatory treatment option for conus medullaris syndrome?

Answer 20

surgical decompression

Question 21

What is the common MOI for cauda equina syndrome?

Answer 21

lumbar burst fx or herniated disc> damage (below L1) to LS roots of peripheral n.

Question 22

what triad presentation might we expect for cauda equina syndrome?

Answer 22

often ASYMMETRICAL saddle anesthesia and LE weekness+ potential bladder dysfn

Question 23

what non-triad presentation might we expect for cauda equina syndrome?

Answer 23

variable sensory loss, flaccid paralysis and areflexia (including in bowel and bladder) , SEVERE LBP

Question 24

what are positive prognostic factors associated with cauda equina syndrome?

Answer 24

PNS injury has potential for nerve regeneration-specifically in the first year (incomplete and often plateaus)

-surgery within 48 hrs of initial presentation

Question 25

What are some prognostic expectations associated with cauda equina syndrome

Answer 25

bladder outcomes worsen with duration of compression

Question 26

What percent of people with conus medullaris syndrome regain function

Answer 26

10%

Question 27

How commonly do we see motor recovery in anterior cord syndromes? Is it a full recovery?

Answer 27

there is about a 10-20% chance of motor recovery and these pts usually demonstrate poor power and coordination .

Question 28

Typically ASIA (not syndromes): How do ASIA results fit into the prognostic indicators for walking after SCI, and what other indicators are available?

Answer 28

ASIA is the #1 prognostic indicator but we also look @ early reflex examination, syndromes, acquired vs traumatic, and age

Question 29

How does the prognosis for conus medullaris syndrome compare to that of cauda equina syndrome?

Answer 29

they have similar prognostic indicator but CM is is less favorable that CES due to UMN involvement