Spinal cord injuries Flashcards
How can spinal cord or nerve roots be damaged?
Contusion, compression, stretch or laceration
vascular disruption
oedema –> ischaemic damage, hypotension
hypoxia and inflammatory responses may also give 2ndary damage
What is spinal shock?
physiological response to injury; complete loss of sensation and motor function and loss of reflexes below level of injury
-usually resolves in 24H; severity of spinal cord injury may not be determined until after shock
What is bulbocavernous reflex?
Reflex contraction of anal sphincter with either a squeeze of the glans penis, tapping the mons pubis, or pulling on a urethral catheter.
It is absent in spinal shock; its return signals end of spinal shock.
What is a reason for neurogenic shock to occur?
secondary to temporary shutdown of sympathetic outflow from T1-L2, usually due to cervical or upper thoracic injury
- leads to hypotension, bradycardia
- resolves usually 24-48H
- Priapism from unopposed parasympathetic stimulation may be present
- Treat with IV fluid therapy
What is a complete spinal cord injury?
sensory or voluntary motor function below the level of injury (reflexes should return)
How do you determine level of injury in complete spinal cord injury?
most distal psinal level with partial function (after spinal shock resolution) determined by:
- dermatomal sensation
- myotomal skeletal muscle contraction
What is prognosis from complete spinal cord injuries?
Poor
Incomplete spinal cord injuries
some neuro function (sensory +/or motor) present distal to level of injury
-greater fxn present, faster recovery, better prognosis
What does sacral sparing indicate?
Sacral sparing with preservation of perianal sensation, voluntary anal spincter, sphincter constriction, and big toe flexion indicates:
some continuity of the corticospinal and spinothalamic tract (course touch, pain, temperature)
= incomplete cord injury with better prognosis than complete injury
