Spinal Cord Disorders

Question 1

Exam Findings of SC Lesion

Answer 1

-bilateral>uni
-B/B
-stiffness in legs
-neck of back pain
-Lhermitte or Uhthoff phenomenon
-sensory level
-tight band sensation across torso (MS hug)

Question 2

Complete Transverse Lesions

Answer 2

-trauma
-tumor
-hemorrhage
-myelits or myelopathy
-epidural abscess

Question 3

Spinal Cord Lesion Progression

Answer 3

Primary:
-compression
-laceration
-shearing

Seconds:
-hypoxia
-hemorrhage
-acidosis

Mins-Hours:
-edema
-vasospasm
-thrombosis
-loss of Na balance
-inflammation
-free radicals

Days-Weeks:
-microglial
-macorphage
-apoptosis

Question 4

Emergent Care of SCI

Answer 4

-immobilization
-airway protection
-avoid hyppotension
-surgical decompression

Question 5

Level of SCI Injury

Answer 5

50.7% cervical
-C5: 14.7%
-C4: 13.2%

35.1% Thoracic
11% Lumbosacral (cauda equina)

Question 6

Spinal Shock

Answer 6

-immediate flaccidity and loss of sensory and autonomic function below level (days to weeks)
-atonic bladder with overflow incontinence
-atonic bowel with gastric dilation
-loss of vasomotor control

Question 7

SCI S/s

Answer 7

-increase reflexes, spasticity
-primative reflexes
-spatic bladder
-autonomic dysreflexia (above T5)
-paralyzed legs with flexion contractures

Question 8

Disabilities Ass. with C1-C5 Tretraplegia

Answer 8

C1-C3
-breathing support
-communication support

C1-C5
-dressing, bathing, comminication
-assistive devices

Question 9

Disabilities Ass. with C6-C8 Tretraplegia

Answer 9

Dressing:
-minimal assistance for UE
-moderate assistance for LE
-C8 able to independently

Bathing:
-moderate assistance for LE
-minimal for UE

Communication:
-independent verbal communication
-set up required for C6

Question 10

Disabilities Ass. with T1-below Paraplegia

Answer 10

independent

Question 11

Autonomic Dysreflexia

Answer 11

-SNS response to noxious stimuli below lesion
-in T5 and above lesions
-risk increases after spinal shock

S/s:
-HTN (>300)
-sweating above injury
-redness above injury
-Bradycardia

Question 12

Autonomic Dysreflexia Triggers

Answer 12

-full bladder
-impacted bowel
-kidney stones
-scrotal compression
-gastritis
-DVT
-period
-ulcers
-change in temp
-irritation below lesion

Question 13

SCI Cardiovascular Complications

Answer 13

-arrhythmias
-BP flucuations
-Orthostatic hyopotension
-PE
-edema

Question 14

SCI Respiratory Complications

Answer 14

-impaired cough
-increased risk of pneumonia
-sleep apnea
-reduced exercise tolerance

Question 15

SCI Nutritional Complications

Answer 15

-high catabolic state
-poor wound healing
-paralytic ileus (poor eating)
-gastric and stress ulcers

Question 16

SCI Skin Complications

Answer 16

-ulcers
-osteomyelittis
-sepsis

Question 17

SCI Sexual Function Complications

Answer 17

Men
-libido, potency, fertility

Women:
-libido, sexual response
-fertility remained

Question 18

Acute SCI Prognosis

Answer 18

-lower life expectancy, highest in 1st year
-depends on severity
-12% employed 1 yr

Leading causes of death
-sepsis
-pneumonia
-respiratory failure

Question 19

Cervical Spondylosis

Answer 19

-most common cause of Myelopathy and rediculopathy
-degenerative disease of spine

C5-C6 MC
-buldging disc
-bone spur
-thickening of ligaments

Question 20

Cervical Spoldylotic Myelopathy

Answer 20

-pain
-burning
-weakness
-N&T
-B/B
-Lhermitte’s

-Early gait impairment,
-LE symptoms sensory if DCML
-lateral arm weakness and loss of finger dexterity
-radicular issues too

Question 21

Spinal Cord Tumors

Answer 21

Intramedullary: w/in SC
Extramedullary-intradural: on surface of cord or meninges
Extradural: eidural space but can compress

Question 22

Spincal Cord Metatases

Answer 22

-70% thoracic, 20% lumbar, 10% cervical

Primary site: lung, breast, prostate, kidney

S/s:
-back bain
-tendrness
-incontinence
-paraparesis

Question 23

Epidural Abscess

Answer 23

-can occur with osteomyelitis or skin infection

S/s:
-fever, back pain, diabetes, radicular pain, sensory loss

Question 24

Anterior Cord Syndrome

Answer 24

-A. Spinal Artery stroke

-Paralysis, analgesia, loss of discriminative sensation, loss of temp below lesion

-Keep proprioception and light touch (DCML)

Question 25

Central Cord Syndrome

Answer 25

-trauma induced
-tumors
-Nueromyelitis optica
-hyperextension
-syringomyelia

Small Lesion: pain and nociception impaired at level of lesion

Large Lesion: pain and nociception impaired at level of lesion AND UE motor issues

S/s: UMNL

Question 26

Brown-Sequard (Hemicord) Syndrome

Answer 26

Ipsilateral segment:
-pareplegia and analgesia of everything

Ipsilateral Below:
-Paralysis and loss of proprioception and light touch
-maintain nociception and temp
-ipaired sweating and nerve root pain

Contralateral Below:
-nociceptive and temp impaired (1-2 levels below)
-maintain motor and light touch/proprioception

Cause:
-penetrating trauma
-MS
-epidural abscess

Question 27

Cauda Equina Syndrome

Answer 27

-sensation impaired, pain, LE paralysis, bowel/bladder
-no hyperreflexia (LMNL)

Causes:
-disc herniation
-vascular
-infections
-radiation
-neoplastic
-inflammatory

Question 28

Posteriolateral Column Syndrome

Answer 28

-chronic
-B12, copper deficiency
-cervical spondylosis
-virus
-posterior colum and corticospinal tracts

S/s:
-weakness (increased refleces, spasticity)
-paresthesias
-sensory ataxia
-gait unsteadiness

Question 29

Posterior Column Syndrome

Answer 29

-cause of nuerosyphilis
-early cervical spondylotic myelopathy
-radiation induced myelopathy

S/s:
-inpaired vibration and proprioception
-sensory ataxia
-gait imbalance

Question 30

Syphilis

Answer 30

-tabes dorsalis
-STD
-causes DCML demeylination
-involes dorsal roots

Question 31

Syringomyelia

Answer 31

-cenntral cavitation of SC
-most common in cervical
-may need drainage

Causes:
-idiopathic
-tumor, hemorrhage, brain malformation

S/s:
-segmental weakness and atrophy of hands
-cape distribution