Spinal cord injuries

Question 1

what different types of damage can occur tot he spinal cord

Answer 1

contusion, compression, stretch or laceration

Question 2

describe what is involved in spinal shock

Answer 2

a physiologic response to injury with complete loss of sensation and motor function, and loss of reflexes below the level of injury

Question 3

how quickly does spinal shock usually resolve

Answer 3

within 24 hours, with return of reflexes

Question 4

describe what the bulbocavernous reflex is

Answer 4

contraction of the anal sphincter with either a squeeze of the glans penis, tapping the mons pubis or pulling on a urethral catheter

Question 5

describe the effect of spina shock on the bulbocavernous reflex

Answer 5

it is absent in spinal shock, with signal returning at end of spinal shock

Question 6

describe the occurrence of neurogenic shock

Answer 6

occurs secondary to temporary shutdown of sympathetic outflow from the cord from T1 to L

Question 7

what injury is neurogenic shock usually due to

Answer 7

cervical or upper thoracic cord injury

Question 8

what does neurogenic shock lead to and how quickly does it resolve

Answer 8

hypotension and bradycardia, also priapism may be present, usually resolves within 24-48 hours

Question 9

what is involved in the treatment of neurogenic shock

Answer 9

IV fluid therapy and must be differentiated from other types of shock

Question 10

in what different ways can spinal cord injuries be classified

Answer 10

as complete or incomplete spinal injuries

Question 11

what does complete spinal cord injury result in

Answer 11

no sensory or voluntary motor function below the level of the injury
(reflexes should return)

Question 12

describe the level of injury in complete spinal cord injuries is determined

Answer 12

by the most distal spinal level with partial function(after spinal shock resolved), determined by presence of dermatomal sensation and myotomal voluntary skeletal muscle contraction

Question 13

describe the prognosis of complete spinal cord injuries

Answer 13

prognosis for recovery is poor

Question 14

describe what is seen clinically in incomplete spinal cord injuries

Answer 14

some neurological function(sensory +/- motor) is present below the level of injury

Question 15

describe the relation between function and the prognosis of incomplete spinal cord injuries

Answer 15

greater the function the faster the recovery and better prognosis

Question 16

describe the clinical features that indicates some continuity of the corticospinal and spinothalamic tracts

Answer 16

sacral sparing with preservation of perianal sensation, voluntary anal sphincter contraction and big toe flexion

Question 17

describe what the presence of sacral sparing indicates

Answer 17

incomplete spinal injury with better prognosis than complete spinal injury

Question 18

what treatment is required for spinal cord injuries

Answer 18

full ATLS primary survey with resuscitation and protection of the cervical and thoracolumbar spine