Spinal

Question 1

Complete SCI

Answer 1

all tracts
no sacral sparing
loss of all sensory and motor below the level
UMN symptoms below lesion

Question 2

Incomplete SCI

Answer 2

often has sacral sparing
varying symptoms depending on location of damage

Question 3

Poliomyelitis and Werdnig-Hoffman disease

Answer 3

lower motor neuron lesions only due to destruction of anterior horns
flaccid paralysis

Question 4

Multiple sclerosis

Answer 4

mostly white matter of cervical region
random and asymmetric lesions due to demyelination
scanning speech (long pauses between syllables and words)
intention tremor
nystagmus

Question 5

ALS

Answer 5

combined upper and lower motor neuron deficits with no sensory deficit
both upper and motor neuron signs

Question 6

Complete occlusion of anterior spinal artery

Answer 6

spares dorsal columns and tract of Lissauer

Question 7

tabes dorsalis (3 syphilis)

Answer 7

degeneration of dorsal roots and dorsal columns; impaired proprioception and locomotor area

Question 8

Syringomyelia

Answer 8

crossing fibers of spinothalamic tract damaged
bilateral loss of pain and temperature sensation

Question 9

Vitamin B12 neuropathy and Friedrich’s ataxia

Answer 9

demyelination of dorsal columns, lateral corticospinal tracts, and spinocerebellar tracts; ataxic gait, Hyperreflexia, impaired position and vibration sense

Question 10

Classic cause of central cord syndrome

Answer 10

slow-growing lesions such as syringomyelia or intramedumedullary tumor

Question 11

Central cord syndrome is most frequently the result of

Answer 11

a hyperextension injury in individuals with long-standing and cervical spondylosis

greater motor impairment in upper compared with lower extremities
bladder dysfunction
variable degree of sensory loss below the level of injury

Question 12

Spinal shock: motor/sensory

Answer 12

occurs due to acute spinal cord trauma

Below SCI - loss of all reflexes, sensation, motor function (flaccid paralysis)

symptoms can improve

Bulbocavernosus reflex lost in shock base and returns at end of shock

Question 13

Spinal shock hypothesis

Answer 13

injury in neurons –> large intracellular to extracellular K+ movement –> decreased axonal transmission

Question 14

neurogenic shock: perfusion/cardiac

Answer 14

caused by severe brain or spinal cord injury/trauma

causes altered autonomic disturbances that lead to distributive shock

often occurs with injury T6 and above

sympathetic NS damage: vasodilation, hypotension, decreased heart rate

parasympathetic NS dominance: bradycardia

temperature regulation: skin warm –> heat loss –> hypothermia

Net: bradycardia, hypotension, hypothermia

Question 15

Autonomic dysreflexia

Answer 15

SCI generally T6 or above

below injury: sympathetic domination –> vasoconstriction, critical unopposed hypertension, pale & cool skin

above injury: parasympathetic domination –> baroreceptors respond, bradycardia, flushing and diaphoresis, vasodilation, pouring headache

Question 16

SCI lesions lower than T6 do not produce super elevated BP because

Answer 16

intact splanchnic innervation allows for compensatory dilation of the splanchnic vascular bed

Question 17

Autonomic dysreflexia: immediate

Answer 17

sit patient upright
remove tight clothing

Question 18

Autonomic dysreflexia: check for cause

Answer 18

bladder fullness
Foley catheter dysfunction
rectal fullness
ulceration/wound

Question 19

Autonomic dysreflexia: correct cause

Answer 19

relieve bladder
fecal disimpaction
wound care

Question 20

Autonomic dysreflexia: correct blood pressure

Answer 20

calcium channel blockers