Spinal Cord Injuries Flashcards
1
Q
Describe the general symptoms and location for dorsal column, spinothalamic and corticospinal tract injuries
A
- Dorsal column is a sensory ascending tract
- Damage leads to ipsilateral symptoms
- Involved in vibration, proprioception, light touch and two point discrimination
- Spinothalamic tract is a sensory ascending tract
- Damage leads to contralateral symptoms
- Involved in pain, temperature and crude touch
- Corticospinal tract is a motor descending tract (red)
- Damage leads to ipsilateral symptoms
2
Q
Describe the possible mechanisms of spinal cord injury
A
- Hyperflexion - forward movement of the head
- Can lead to fractures or dislocations
- Often leads to neurological injury
- Hyperextension - backward movement
- Can lead to fractures or dislocations
- Lateral stress - sideways movement
- Rotation - twisting of head
- Compression - force along the axis of the spine downward from the head or upward from the pelvis
- Distraction - pulling apart of the vertebrae
3
Q
Describe complete cord transection syndrome and its causes
A
- Bilateral loss of all modalities
- Causes
- Trauma
- Infarction
- Transverse myelitis - bilateral inflammation of the spinal cord at a specific level
- Abscess
- Tumour
4
Q
Describe the clinical features of complete cord transection syndrome
A
- Spinal shock and autonomic dysfunction with higher lesions
- Complete loss of sensation below the lesion
- Complete paralysis below the lesion
- Hypotension
- Priapism - prolonged sustained erection
- Abrupt loss of sympathetic input leads to increases parasympathetic drive
- Leads to vasodilation - causing erection and hypotension
5
Q
Describe brown-sequard syndrome and its causes
A
- Hemisection of cord - unilateral cord compression/injury
- Causes
- True hemisection is rare
- Penetrating trauma
- Fractured vertebrae
- Tumour
- Abscess
- Multiple sclerosis
6
Q
Describe the clinical features of brown-sequard syndrome
A
- Side of injury
- Loss of motor function - corticospinal tract
- Loss of dorsal column modalities
- Contralateral side of injury
- Loss of spinothalamic tract modalities
7
Q
Describe anterior cord syndrome and its causes
A
- Bilateral loss of anterior horn of spinal cord
- Causes
- Often occur as a result of flexion injury
- Leads to fractures of dislocation of vertebrae or herniated discs
- Anterior spinal artery injury
- Vascular or atherosclerotic disease in the elderly
- Iatrogenic secondary to cross-clamping of the aorta intraoperatively
- Often occur as a result of flexion injury
8
Q
Describe the clinical features of anterior cord syndrome
A
- Flaccid paralysis below level of lesion - corticospinal
- Loss of spinothalamic tract modalities on both sides
- Autonomic dysfunction - bowel, bladder, sexual dysfunction
- Preservation of dorsal column modalities
9
Q
Describe central cord syndrome and its causes
A
- Bilateral progressive loss of modalities
- Can grow in all places and does not have to be symmetrical
- Causes
- Trauma
- Hyperextension injury of cervical spine in elderly
- Hyperflexion injury of cervical spine in younger patients
- Disruption of blood flow to the spinal cord
- Cervical spinal stenosis
- Degenerative spinal disease - ligamentum flavum compresses spinal cord
- Central canal ependyoma - tumour
- Syringomyelia
- Trauma
10
Q
Describe syringomyelia and its clinical features
A
- Development of a 3D cyst (syrinx) in or within the central canal
- Initial symptoms arise from the obliteration of spinothalamic fibres decussating in the white commissure
- Loss of temperature, pain, crude touch at spinal levels of cyst
- Preserved dorsal column modalities
11
Q
Describe the clinical features of central cord syndrome
A
- Upper limb motor fibres more medial for corticospinal tracts - upper limb motor functions more affected, also because damage mostly occurs in the cervical spine
- Distal aspects of limb more affected than proximal - lateral corticospinal tract (more involved in distal muscles) affected more than ventral corticospinal tract
- Motor symptoms more extreme than sensory symptoms due to damage to ventral horns
- Loss of spinothalamic modalities at the level of cyst development
- Bladder dysfunction and urinary retention
12
Q
Describe posterior cord syndrome and its causes
A
- Bilateral loss of dorsal column
- Causes
- Very rare syndrome
- Likely due to chronic pathological process rather than trauma - spondylosis, spinal stenosis, infections, vitamin B12 deficiency
- Occlusion/infarction of the paired posterior spinal arteries (supply posterior cord)
13
Q
Describe the clinical features of posterior cord syndrome
A
- Bilateral loss of dorsal column modalities
- Preservation of motor function and spinothalamic modalities
14
Q
Describe the overall management of cord injuries
A
- Non-surgical
- Consider intubation (C5 or above) - loss of innervation to diaphragms and airways
- ICU admission
- Early immobilisation of the C-spine
- C-spine restriction is maintained for approximately 6 weeks
- Physical and occupational therapy
- Surgical
- Progressive neurological deficits
- Unstable spinal fractures
- Progressive neurological deficits
15
Q
Describe the initial evaluation and management of spinal cord injury
A
- ABCDE approach
- Consider intubation for injuries at C5 or above
- Use log roll, backboard and rigid C-collar
- Use manual inline stablisation if suspected spinal injury
