SCI syndromes Flashcards
anterior cord syndrome cause
flexion injuries
burst fracture
anterior cord syndrome what is lost
- motor function
- anteriolateral ( pain / temp)
BELOW level of leison bilaterally
anterior cord syndrome what is intact
medial lemniscal pathways
( fine touch, proprioception, vibration)
prognosis for anterior cord syndrome
**POOR **
bowel and bladder function, hand function, and ambulation = extremely poor prognosis
central cord syndrome cause
**hyperextension injury
patient populations likely to experience CCS
- elderly : prior hx of spondylosis or stenosis, relatively minor trauma can trigger
- younger people: high speed accidents
central cord syndrome presentation
**UE >LE
Sacral sparing*
sensory and motor deficit
central cord syndrome almost exclusively is a —– injury
cervical injury
9% of all traumatic SCI injuries
central cord prognosis
average**
1. younger vs. older patient ambulatory function ( 90% vs. 41%) –> younger = way better ambulatory prognosis
2. B & B ( >50% will recover)
3. Intrinsic hand function last to return ( < 50%)
6 Positive prognostic factors central cord syndrome
- good hand function
- signs of early motor recovery
- young age
- absence of spasticity
- pre-injury employment
- no LE motor impairments at rehab admission
Brown Sequard Syndrome cause
knife wound
gun shot wound
Brown Sequard Syndrome damage down primarily to —– side of cord
one side of cord affected –> incomplete injury
Brown Sequard Syndrome presentation
**Ipsi: **
1. Motor
2. Medial Lemniscal/ Dorsal column: fine touch, proprioception, vibration
3. spasticity
Contra
1. anteriolateral ( pain and temp)
Brown Sequard Syndrome prognosis
Good
1. nearly all pts will regain amulatory fxn
2. hand function ( 80%)
3. bladder control ( 100%) and bowel control ( 80%)
Posterior cord syndrome cause?
- B12 deficiency
- PSA infarct
- compression due to disc or tumor
What is lost in posterior cord syndrome?
- medial lemniscus
( fine touch, proprioception, and vibration)
BELOW level of injury goneee
What is preserved in posterior cord syndrome?
- motor
- pain / temp
thereeee
prognosis of posterior cord syndrome
Good
What is the common SCI injury?
central cord syndrome
What is the least common spinal cord injury ?
posterior cord syndrome
Conus Medullaris is damages what structures?
sacral and lumbar nerve roots
Conus Medullaris common causes?
trauma, tumors , infections
and stenosis
Conus medullaris will present with symptoms
sudden onset of **LMN and UMN **
2 key characteristics of conus medullaris
- symmetrical saddle anesthesia
- symmetrical weakness and flaccidity
Conus meduallaris: Tone, reflexes, and pain responses
- Tone: hyper
- Reflexes: areflexive in distal LE
** may see intact sacral reflexes - pain: mild low back pain and radicular symptoms
Conus medullaris bowel and bladder status
- urinary retention
- atonic anal sphincter
- also sexual dysfunction
Cauda equina is damage to what structures
BELOW L1 to lumosacral roots of peripheral nerve
important consideration when classifying cauda equina syndrome
LMN injury –> cord is spared
“ not a true SCI” –> PNS injury
Cauda equina common cause
lumbar fracture
herniated disc
Cauda Equina common triad
- asymmetrical saddle anesthesia
- asymmetrical LE weakness
- bowel and bladder dysfxn
Cauda Equina: sensory, reflexes, B and B, and pain
- sensory: highly variable ( can be either partial vs. incomplete)
- areflexia ( no sacral reflexes)
- bowel and bladder: flaccid paralysis
- pain: severe LBP, severe radicular pain
Which has a better prognosis Cauda Equina or conus medullaris?
Cauda Equina because nerves have potential to regenerate in peripheral injury
