Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Neuro PA 2015 > Spinal Cord Injuries > Flashcards

Spinal Cord Injuries Flashcards

1
Q

MC causes of spinal cord injury (in order of frequency)

Most common in older pts?

A
  1. Motor vehicle accidents**
  2. Gunshot wounds (violence)
  3. Falls
  4. Sports injuries
  • Increasingly largely due to MVAs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Dermatomes

A
  • Trigeminal
  • Cervical
  • Thoracic
  • Lumbar
  • Sacral
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Spinal Cord Anatomy: Corticospinal Tracts

A
  • Motor from cerebral cortex
  • Cross in lower medulla
  • Control motor fxn on same side of body
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Spinothalamic Tracts

A
  • Pain and temp
  • Cross 1-2 levels above entry
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Anterior Cord

A
  • Spinothalamic tracts (lateral columns)
  • Pain (pinprick)
  • Temperature
  • Light touch
    • From opposite side of body**
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Anterior Cord Syndrome

A
  • Cause
    • pressure on paired anterior spinal arteries
    • damage by bony fragments
  • Damage
    • bilateral spinothalamic tracts
    • bilateral corticospinal tracts
  • Result
    • complete loss of:
      • distal motor fxn
      • pain and temp sensation
      • light touch sensation
    • Sacral sparing
  • Position and Vibration are PRESERVED**
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Posterior Columns

A
  • Light touch
  • Pressure
  • Joint position (proprioception) and vibration
    • same side of body
  • Same level entry
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Posterior Cord Syndrome

A
  • Cause
    • hyperextension injuries (cervical)
      • falls on face/chin
  • Damage to corticospinal tracts and posterior columns
  • Retained spinothalamic fxn (pain and temp)
  • Lost movement? but still intact (corticospinal) and proprioception (posterior column)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Brown-Sequard Syndrome

A
  • Cause
    • penetrating trauma**
  • Damage
    • ALL tracts on ONE SIDE of the cord
  • Results
    • isolated loss of ALL fxns
      • motor - SAME SIDE as damage
      • position/vibration - SAME SIDE as damage
      • pain/temp - OPPOSITE SIDE as damage
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Complete Transection

A
  • MOST SERIOUS
  • Cause
    • trauma
  • Damage
    • ALL tracts on BOTH SIDES
  • Results
    • total loss of fxn on BOTH SIDES
  • Initially areflexia
  • Becomes hyperreflexia, spasticity, pos. plantar reflex
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Atlanto-Occipital Disassociation

A
  • “Hangman’s Fracture”**
  • Severe flexion of the atlas C1
  • Can cause dislocation/disassociation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Spinal cord vascular supply: Radicular arteries from aorta

A
  • Great Radicular artery of Adamkiewicz**
  • T10 - L2**
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Spinal Shock

A
  • Loss of motor and sensory after trauma
    • total lack of fxn
  • Absent reflexes and flaccid paralysis
    • lasts a week to several months
  • End of spinal shock
    • signaled by muscular spasticity
    • reflex bladder emptying
    • hyperreflexia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Neurogenic Shock

A
  • Sympathetic chain
  • Associated with autonomic instability
    • dec. BP
    • dec. RR
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Central Cord Syndrome

A
  • Damage
    • Central Spinothalamic tracts
    • Central Corticospinal tracts
  • Upper extremity weakness > Lower
  • Associated w/ FALLS (elderly w/ spondylosis/stenosis)
  • Can’t lift ARMS
    • look like they’re in a “barrel”
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Cauda Equina/Conus Medularis

A
  • CONUS MEDULARIS
    • S3-S5
      • spinal cord ends at L2**
    • Saddle anesthesia **
      • numbness in seat (saddle) area
    • Sphincter loss
    • Intact LE motor and sensory
  • CAUDA EQUINA
    • Spinal cord ends at L2**
    • Injury to lumbosacral roots
    • Bowel/bladder deficits
17
Q

Level of Injury

A
  • Cervical (C1 - T1)
  • Thoracic (T1 - L1)
  • Lumbar (L1 - S1)
18
Q

Thromboembolic Disease

A
  • 200x more likely to die of PE in 1st year
  • Prophylactic Strategies
    • Pneumonic compression devices
    • Unfractionated heparin (Lovenox)
    • Caval filters
      • pts w/ high cord lesions
19
Q

High Thoracic and Cervical Lesions

A
  • Above T6
  • Loss of supraspinal control of sympathetic activity
20
Q

Acute SCI (autonomic dysfuntion)

A
  • Low sympathetic activity
21
Q

Chronic SCI (autonomic dysfunction)

A
  • High sympathetic activity
22
Q

Autonomic Dysfunction

A
  • High thoracic and cervical lesions (above T6)
    • Loss of supraspinal control of sympathetic activity
  • Acute SCI
    • Low sympathetic activity**
  • Chronic SCI
    • High sympathetic activity**
  • Resting BP low
  • Bradycardiac
    • resolves after 1st week
  • Orthostatic changes
    • weakness
    • lightheadedness
    • syncope
  • Management
    • Mobilization
    • Lots of Na**
    • Compression socks
    • Fludrocortisone acetate** 0.1 mg PO QD
      • vol. expansion (inc. BP)
23
Q

Autonomic Hyperreflexia

A
  • Lesions above T7-T8 (variation)
  • Unmodulated sympathetic response to stimuli below level of lesion
    • Bladder distention**
    • Fecal impaction**
  • Symptoms (EMERGENCY)
    • SEVERE HA
    • HYPERTENSION
    • BRADYCARDIA
  • Management
    • Sitting position (dec. ICP)
    • Check for stimulus
    • Minimize noxious stimuli
    • Nifedipine/Nitrate** (1st line)
      • AVOID Nitrate if using Sildenafil (Viagra)
    • Alpha blocking agent (Terazosin)
    • ADMIT
24
Q

Neuropathic Spinal Pain

A
  • Occurs at or below injury level
  • Results from
    • change in neuronal function
    • inc. spontaneous activity
    • dec. threshold of response
  • Descriptors
    • temp
    • electric
  • Look for other causes of pain
  • Tx
    • PT
    • Anticonvulsants
    • Antidepressants
25
Q

Neurogenic Bladder Dysfunction

A
  • Initial
    • bladder flaccidity
    • keeps getting fuller
  • Later
    • reflexes return w/ suprasacral injury
  • Acute
    • indwelling catheter
  • Detrusor Sphincter Dyssynergy**
    • bladder reflex and sphincter working against each other
    • Management to avoid renal damage!
    • Clean intermittent Catheterizations (best tx)
    • Reflex voiding into condom catheter (lower lever injury - paraplegic pts)
26
Q

Neurogenic Bowel Dysfunction

A
  • Constipation
  • Reflexes allowing defecation may be intact
  • CAUDA EQUINA
    • lower motor neuron (LMN)
    • causes constipation
    • incontinence (flaccid sphincter)
  • Treatment
    • manual disimpaction
    • stimulants
27
Q

Hypertrophic Bone Formation

A
  • New bone formation in soft tissue surrounding joint
    • MC hip**
  • Presentation
    • Lower extremity swelling
    • Dec. hip ROM
    • Fever
  • Treatment
    • ROM exercise
    • NSAIDs
    • Irradiation
    • Etridronate** (bisphosphonate)
28
Q

Spasticity

A
  • Resistance to passive movement
  • Good because:
    • It’s easier to move pt
      • harder to work with flaccid paralysis
    • inc. circulation
    • dec. risk of DVT and osteoporosis
  • Disadvantage
    • positioning
    • painful
  • Treatment
    • Baclofen** (1st line)
      • GABA-B analog (centrally acting)
    • Tizanidine (2nd)
    • Diazepam (3rd)
29
Q

ASIA Impairment Scale

A
  • A: complete (severed)
  • B: incomplete (sensory intact, but no motor fxn below injury)
  • C: incomplete (motor fxn preserved below level)
    • muscle grade <3
  • D: incomplete (motor fxn preserved below level)
    • muscle grade >3
  • E: normal
30
Q

Cervical Extension Teardrop Fracture

A
  • Abrupt neck extension
  • C5 - C7
  • MVA
  • Central cord syndrome
  • Similar to Flexion teardrop fracture
31
Q

Quadriplegia

A
  • C1 - C8
32
Q

Paraplegia

A
  • T1 - L4
33
Q

Cardiovascular System

A
  • C1 - T5
    • dec. SNS influence
  • Bradycardia
  • Hypotension
34
Q

Respiratory

A
  • C1 - C3:
    • can’t breath independently
  • C4:
    • poor cough
    • diaphragmatic breathing
    • hypoventilation
  • C5 - T6:
    • dec. resp reserve
  • T6 or T7 - L4:
    • resp system functional
    • adequate reserve
35
Q

L5 - S1 Disc Prolapse

A
  • No ankle jerk reflex
    *

Neuro PA 2015 (3 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions