SCI - Teacher Questions Flashcards
Spinal Cord Lesions
ASCIA defines complete neurologic lesions as?
Absence of sensory & motor function below the level of injury
Spinal Shock
When does it occur?
When does Autonomic dysreflexia occur?
In the acute phase following the SCI
In the chronic phase of the SCI
Spinal Shock
What is it? How is it resolved?
The pt loses all reflexes - flacid paralysis
The symptoms will resolve with the return of the bulbo-cavernosus reflex (squuezing the mans penis gands or touching womens clitors and wathcing for the anal sphincter to respond)
The symptoms will resolve with elcitable abnormal cutaneospinal or muscle spindle reflex arcs
Can’t be diagnosed until the shock as resolved
50% of patient recover (walk) or some improvement
Soderstorm Demonstrates
What % of patients with blunt trauma & SCI HAVE hypotension (spinal shock) secondary to SCI?
What explains the other some %?
70%
Blood loss exlpains the other 30% of patients with hypotension and SCI
Tell me about the Primary descendin tracts?
meaning motor
5
Called the cortico-spinal tracts
Originate in the cerebral cortex
90% cross the lateral cortico-spinal tracts
—–these then synapse with the lower motor neurons in the cord
10% don’t cross but instead descend via the anterior funiculus of the cervical spine & upper thoracic as the ventral cortico-spinal tract
Damage will result in ipsilateral motor deficits
Tell me about the Primary Ascending Tracts?
Meaning sensory - hint
What should you consider carrying?
Called the spino-thalamic tracts
The injury is typically across from the secondary neuron - cross the spine 2 levels above tje peripheral presentation
The patient will have contra-lateral presentation
It affects all dorsal columns (tracts)
Pain sense
Temperature gun
Crude touch test
Fine touch test
Proprioception & vibration
What do the posterior white columns include?
Fasciceli cuneatus
Gracilis
Medial lemniscal
Describe the presentation of a C-5 injury
still have use of the deltoid and bicep muscles, meaning they will be able to raise their arms up and bend their elbows
will most likely have severe weakness or total paralysis of the wrists, hands, trunk, and legs
What is sacral sparing, how is it tested and what does it represent
determines whether a spinal cord injury (SCI) is classified as neurologically complete or incomplete.
It’s when the patient maintains sensation around their anal region (sphincter)
light touch or pin prick sensation at the S4-5 dermatome, deep anal pressure, or voluntary anal sphincter contraction
Explain NPR
Neurogenic parodoxial respirations
Describe SCIWORA
Spinal Cord Injury without Radiographic Abnormality
a term that denotes objective clinical signs of post-traumatic spinal cord injury without evidence of fracture or malalignment on plain radiographs and CT of the spine.
Accounts for 2/3rds of cervical injuries in children less than 8y/o
Caused by
- hyperextension
- Traction
- Spinal cord damage
Secondary to edema or vascular damage
defined spinal stability (and therefore instability
spinal stability is the ability of the spine under physiologic loads to limit patterns of displacement so as not to damage or irritate the spinal cord and nerve roots and, in addition, so as to prevent incapacitating deformity or pain due to structural changes
instability (acute or chronic) refers to excessive displacement of the spine that would result in neurologic deficit, deformity, or pain.
Describe the various long term problems associated with SCI
deep vein thrombosis
urinary tract infections
muscle spasms
osteoporosis
pressure ulcers
chronic pain
respiratory complications
Initial - low blood pressure when you rise (orthostatic hypotension) to swelling of your extremities
What % of all spinal cord Injuries occur without detectable vertebral findings?
How can the cord get penetrated?
10%
bony fragments
herniated disks
epidural hematoma
What are the most likely areas of the spine to be injured?
C3
C4
C5
