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Sem 4 - Nervous System > Spinal Cord Injuries > Flashcards

Spinal Cord Injuries Flashcards

1
Q

What is the most common cause of spinal injuries?

A

Physical trauma

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2
Q

Are spinal injuries more common in males or females?

A

Males

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3
Q

What spinal levels do spinal injuries most commonly occur at?

A

Half occur at C6 or C7

30% occur at C2

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4
Q

What spinal levels do injuries most commonly occur at in children? Why?

A

C1, C2

Heavier head, lax ligaments

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5
Q

What are the different mechanisms of spinal injury? What do they each mean?

A

Hyperflexion, forward movement of the head

Hyperextension, backward movement of the head

Lateral stress, sideways movement of the head

Rotation, twisting of the head

Compression, force along the axis of the spine downward from the head or upward from the pelvis

Distraction, pulling apart of the vertebrae

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6
Q

What are some examples of flexion injuries?

A

Atlanto-occipital dislocation

Atlanto-axial dislocation

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7
Q

What are some examples of extension injuries?

A

Hangman’s fracture

Atlanto-axial dislocation

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8
Q

What are the different types of cord injuries?

A

Complete cord transection syndrome

Brown-Sequard syndrome

Anterior cord syndrome

Central cord syndrome

Posterior cord syndrome

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9
Q

What is complete cord transection syndrome?

A

Injury to a whole section of the spinal cord

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10
Q

What are the causes of complete cord transection syndrome?

A

Trauma

Infarction

Transverse myelitis

Abscess

Tumour

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11
Q

What is transverse myelitis?

A

Inflammation of both sides of one section of the spinal cord

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12
Q

What spinal tracts are injured in complete cord transection syndrome?

A

All of them

  • dorsal-column medial-lemniscus pathway
  • spinothalamic tract
  • corticospinal tract
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13
Q

What are the signs and symptoms of complete cord transection syndrome?

A

Complete loss of all sensory modalities below the lesion

Flaccid paralysis followed by UMN lesion signs below the lesion

Autonomic dysfunction

  • hypotension
  • priapism
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14
Q

What is priapism?

A

Prolonged sustained erection

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15
Q

What are the types of complete cord transection syndromes?

A

Paraplegia

Tetraplegia/quadriplegia

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16
Q

What is paraplegia?

A

Complete cord transection syndrome in the thoracic, lumbar or sacral regions affecting the lower limbs

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17
Q

What are the causes of Brown Sequard syndrome?

A

Penetrating trauma

Fractured vertebrae

Tumour

Abscess

Multiple sclerosis

-all giving unilateral cord injury

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17
Q

What is tetraplegia/quadriplegia?

A

Complete cord transection syndrome in the cervical region affecting both upper limbs and lower limbs

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19
Q

What are the causes of anterior cord syndrome?

A

Flexion injury

Injury to anterior spinal artery

19
Q

What is anterior cord syndrome?

A

Injury to the anterior half of a section of the spinal cord

21
Q

How does flexion injury lead to anterior cord syndrome?

A

Fracture

Dislocation

Herniated discs

22
Q

What can cause injury to the anterior spinal artery?

A

Vascular disease
-atherosclerotic disease

Cross-clamping of aorta during surgery, gives reduced blood flow through anterior spinal artery

23
Q

What spinal tracts are injured in anterior cord syndrome?

A

Spinothalamic tract

Corticospinal tract

24
Q

What are the signs and symptoms of anterior cord syndrome?

A

Loss of temperature, pain, pressure modalities below the lesion

Flaccid paralysis followed by UMN lesion signs below the lesion

Autonomic dysfunction

  • bowel problems
  • bladder problems
  • sexual problems
25
Q

What is central cord syndrome?

A

Injury to the middle of a section of the spinal cord

26
Q

What are the causes of central cord syndrome?

A

Trauma

Ischaemia of spinal cord

Cervical spinal stenosis

Degenerative spinal disease

Syringomelia

27
Q

How does trauma cause spinal cord syndrome?

A

Hyperextension injury of cervical spine in elderly

Hyperflexion injury of cervical spine in younger people

28
Q

What is syringomelia?

A

Development of cyst in central canal

28
Q

What causes syringomelia?

A

Unknown cause

29
Q

What spinal tracts are injured in syringomelia?

A

Spinothalamic fibres decussating in white commissure

30
Q

What are the signs and symptoms of syringomelia?

A

Loss of temperature, pain and pressure modalities

In the neck, shoulders and arms as cervical fibres are more medial

32
Q

What are the causes of posterior cord syndrome?

A

Spondylosis

Spinal stenosis

Infections

Vitamin B12 deficiency

Injury of paired posterior spinal arteries

32
Q

What are the signs and symptoms of central cord syndrome?

A

More motor symptoms than sensory symptoms

Upper half of body affected more than lower half of body, due to nerve fibres of upper half of body being more medial in corticospinal tract

Distal extremities affected more than proximal

Autonomic dysfunction
-urinary retention

34
Q

What spinal tracts are injured in posterior cord syndrome?

A

Dorsal-column medial-lemniscus pathway

35
Q

What are the signs and symptoms of dorsal-column medial lemniscus pathway?

A

Loss of light touch, proprioception, vibration modalities below the lesion

36
Q

What signs and symptoms suggest the patient has a spinal cord injury?

A

Head injury

Unconscious, confused

Spinal tenderness

Loss of sensation

Extremity weakness

37
Q

How are spinal cord injuries immediately managed?

A

ABCDE approach

Manual inline stabilisation for short-term

Log-roll, backboard, rigid C-collar for long-term

Assess bladder volume, insert urinary catheter

38
Q

What parts of the ABCDE approach are particularly important with a spinal cord injury?

A

Monitor vital signs e.g. heart rate, blood pressure, respiratory rate, % saturation, temperature

If patient is hypotensive, give fluid challenge and vasoconstrictors e.g. adrenaline

If patient is not breathing, if injury is C5 or above meaning loss of innervation to diaphragm, intubate patient

If patient is hypoxic, give oxygen

If patient has hypothermia, give blankets

39
Q

Why do patients with spinal cord injuries become hypotensive?

A

Loss of sympathetic output

Vasodilation, decreased systemic vascular resistance and hence blood pressure

40
Q

Why do patients with spinal cord injuries become hypothermic?

A

Loss of sympathetic output
Vasodilation of arterioles in skin, loss of heat by radiation

Loss of piloerection reflex, can’t conserve heat

Loss of voluntary motor output, can’t shiver to generate heat

41
Q

Why do patients with spinal cord injury get urinary retention?

A

Flaccid paralysis of bladder detrusor muscle

42
Q

What is manual inline stabilisation?

A

Crouching above the patient, hands placed on mastoid process or cradle their occipital

Or standing beside patient, hands placed on sides of heads, forearms resting on patient’s chest

43
Q

How are spinal cord injuries managed after the patient is stable?

A

C-spine restriction for approx. 6 weeks

Physiotherapy, occupational therapy

Surgery if neurological deficits are progressing, or to correct unstable spinal fractures

44
Q

What is meant by clearing the spine?

A

Removing the C-collar

45
Q

What are the criteria for clearing the spine?

A

Alert and oriented

Not intoxicated

No midline posterior tenderness

No focal neurological deficit

No language barrier

Sem 4 - Nervous System (25 decks)

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