Spinal Cord Disorders Flashcards
Exam Findings of SC Lesion
-bilateral>uni
-B/B
-stiffness in legs
-neck of back pain
-Lhermitte or Uhthoff phenomenon
-sensory level
-tight band sensation across torso (MS hug)
Complete Transverse Lesions
-trauma
-tumor
-hemorrhage
-myelits or myelopathy
-epidural abscess
Spinal Cord Lesion Progression
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
Emergent Care of SCI
-immobilization
-airway protection
-avoid hyppotension
-surgical decompression
Level of SCI Injury
50.7% cervical
-C5: 14.7%
-C4: 13.2%
35.1% Thoracic
11% Lumbosacral (cauda equina)
Spinal Shock
-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
SCI S/s
-increase reflexes, spasticity
-primative reflexes
-spatic bladder
-autonomic dysreflexia (above T5)
-paralyzed legs with flexion contractures
Disabilities Ass. with C1-C5 Tretraplegia
C1-C3
-breathing support
-communication support
C1-C5
-dressing, bathing, comminication
-assistive devices
Disabilities Ass. with C6-C8 Tretraplegia
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
Disabilities Ass. with T1-below Paraplegia
independent
Autonomic Dysreflexia
-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
Autonomic Dysreflexia Triggers
-full bladder
-impacted bowel
-kidney stones
-scrotal compression
-gastritis
-DVT
-period
-ulcers
-change in temp
-irritation below lesion
SCI Cardiovascular Complications
-arrhythmias
-BP flucuations
-Orthostatic hyopotension
-PE
-edema
SCI Respiratory Complications
-impaired cough
-increased risk of pneumonia
-sleep apnea
-reduced exercise tolerance
SCI Nutritional Complications
-high catabolic state
-poor wound healing
-paralytic ileus (poor eating)
-gastric and stress ulcers
SCI Skin Complications
-ulcers
-osteomyelittis
-sepsis
SCI Sexual Function Complications
Men
-libido, potency, fertility
Women:
-libido, sexual response
-fertility remained
Acute SCI Prognosis
-lower life expectancy, highest in 1st year
-depends on severity
-12% employed 1 yr
Leading causes of death
-sepsis
-pneumonia
-respiratory failure
Cervical Spondylosis
-most common cause of Myelopathy and rediculopathy
-degenerative disease of spine
C5-C6 MC
-buldging disc
-bone spur
-thickening of ligaments
Cervical Spoldylotic Myelopathy
-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
Spinal Cord Tumors
Intramedullary: w/in SC
Extramedullary-intradural: on surface of cord or meninges
Extradural: eidural space but can compress
Spincal Cord Metatases
-70% thoracic, 20% lumbar, 10% cervical
Primary site: lung, breast, prostate, kidney
S/s:
-back bain
-tendrness
-incontinence
-paraparesis
Epidural Abscess
-can occur with osteomyelitis or skin infection
S/s:
-fever, back pain, diabetes, radicular pain, sensory loss
Anterior Cord Syndrome
-A. Spinal Artery stroke
-Paralysis, analgesia, loss of discriminative sensation, loss of temp below lesion
-Keep proprioception and light touch (DCML)
Central Cord Syndrome
-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
Brown-Sequard (Hemicord) Syndrome
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
Cauda Equina Syndrome
-sensation impaired, pain, LE paralysis, bowel/bladder
-no hyperreflexia (LMNL)
Causes:
-disc herniation
-vascular
-infections
-radiation
-neoplastic
-inflammatory
Posteriolateral Column Syndrome
-chronic
-B12, copper deficiency
-cervical spondylosis
-virus
-posterior colum and corticospinal tracts
S/s:
-weakness (increased refleces, spasticity)
-paresthesias
-sensory ataxia
-gait unsteadiness
Posterior Column Syndrome
-cause of nuerosyphilis
-early cervical spondylotic myelopathy
-radiation induced myelopathy
S/s:
-inpaired vibration and proprioception
-sensory ataxia
-gait imbalance
Syphilis
-tabes dorsalis
-STD
-causes DCML demeylination
-involes dorsal roots
Syringomyelia
-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
