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Neurodegenerative diseases > Spinal cord injury > Flashcards

Spinal cord injury Flashcards

1
Q

what percentage of new spinal cord injuries occur in males?

A

80%

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2
Q

why is pneumonia one of the leading complications and causes of death after a spinal cord injury (SCI)?

A

After a cervical or thoracic lesion, impairment of the respiratory muscles decreases respiratory function, which increases the risk of respiratory complications

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3
Q

what is the leading cause of death in patients with SCI?

A

respiratory disorders

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4
Q

why is septicaemia a common cause of death in SCI patients?

A

(as a patient is not able to move on their own they will get bed sores and not able to fight off infection
Sepsis can arise from virtually any type of infection and both incidence and clinical presentation vary between different patient populations. Since infections are a common complication in individuals with spinal cord injury (SCI), a comparable risk to develop sepsis can be assumed in this population.

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5
Q

what are the most common causes of spinal cord injury?

A
  • motor vehicle accidents 38%
  • falls 30%
  • acts of violence 14%
  • sporting accidents 9%
  • other 9%
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6
Q

what are the 5 spinal cord levels?

A

Cervical 1- Cervical 8 (C1-C8)
Thoracic 1 – Thoracic 12 (T1-T12)
Lumbar 1 – Lumbar 5 (L1–L5)
Sacral 1 – Sacral 5 (S1-S5)
Coccygeal 1 (Co1)

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7
Q

how many spinal nerves are there?

A

(31 spinal nerves)
Cervical 1- Cervical 8 (C1-C8)
Thoracic 1 – Thoracic 12 (T1-T12)
Lumbar 1 – Lumbar 5 (L1–L5)
Sacral 1 – Sacral 5 (S1-S5)
Coccygeal 1 (Co1)

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8
Q

what information is carried in the spinal cord?

A

ascending sensory information moves up towards the brain from the sensory nerves
descending motor information comes from the brain to the muscles/motor neurons

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9
Q

what information does the posterior columns carry?

A

they carry sensory information about vibration, light touch and proprioception along the ascending pathway to the brain

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10
Q

what information does the lateral corticospinal tract carry?

A

it carries motor information on fine motor control along the descending pathway to the muscles

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11
Q

what information does the anterioror spinothalamic tract carry?

A

sensory information about pain and temperature along the ascending pathway to the brain

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12
Q

what is parapalegia?

A

paralysis that affects your legs, but not your arms.
This symptom is most likely to happen with injuries, but can also happen because of diseases or medical conditions

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13
Q

what is quadrapalegia?

aka tetrapalegia

A

a symptom of paralysis that affects all a person’s limbs and body from the neck down.
The most common cause of quadriplegia is an injury to the spinal cord in your neck, but it can also happen with medical conditions.

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14
Q

at C4 injury would result in…

A

quadriplegia - complete paralysis below the neck

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15
Q

a C6 injury would result in…

A

partial paralysis of hands and arms as well as lower body
(quadriplegia but has control of shoulders)

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16
Q

a T6 injury would result in…

A

Paraplegia - paralysis below the chest

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17
Q

a L1 injury results in…

A

Paraplegia - paralysis below the waist

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18
Q

an injury at which spinal nerve would result in loss of control of the lungs?

A

above C3 or C2

19
Q

which spinal nerves, if injured, is likely not survivable?

A

C1 or upper C2

20
Q

in a survey of paraplegics and quadriplegic, what function did each say they would most want recovered?

A

in quadriplegics they priotised arm/hand function
in paraplegics they priotised sexual function

21
Q

what is brown-sequard syndrome?

A

Brown-Séquard syndrome is a rare spinal disorder that results from an injury to one side of the spinal cord in which the spinal cord is damaged but is not severed completely.
results in weakness or paralysis on one side of the body and a loss of sensation on the opposite side (of the lesion).

22
Q

what is central cord syndrome?

A

(also known as central cervical cord syndrome) is the most common form of an “incomplete spinal cord injury”—one in which the spinal cord’s ability to transmit some messages to or from the brain is damaged or reduced below the site of injury to the spinal cord
It leads to motor deficits that are more pronounced in the upper extremities compared to the lower extremities, as well as bladder dysfunction (retention) with sacral sparing

is considered “incomplete” because patients are usually not completely paralyzed

is an incomplete traumatic injury to the cervical spinal cord – the portion of the spinal cord that runs through the bones of the neck.

23
Q

how are SCI diagnosed?

A

Using the ASIA (American Spinal Injuries Assiciation)

24
Q

what is the ASIA scale?

A

(American Spinal Injuries Association)
ASIA scale is an indicator of severity of SCI used clinically (A-E).
* Determines sensory levels for right and left sides.
* Determines motor levels for right and left sides.
* Determines single neurological level – lowest spinal level that is normal on both sides.
* Determines whether is injury is complete or incomplete.
ASIA A is a complete injury then ASIA E is normal

25
Q

what categories does the ASIA scale look at to determine the SCI severity?

A
  • Determines sensory levels for right and left sides.
  • Determines motor levels for right and left sides.
  • Determines single neurological level – lowest spinal level that is normal on both sides.
  • Determines whether is injury is complete or incomplete
26
Q

on the ASIA impairment scale what does A indicate?

A

complete - no motor or sensory function is preserve in the sacral segments S4-S5

27
Q

on the ASIA impairment scale what does B indicate?

A

Incomplete - sensory but no motor function is preserved below the neurological level and includes the sacral segments S4-S5

28
Q

n the ASIA impairment scale what does C indicate?

A

incomplete - motor function is preserved below the neurological level and more than half of key muscles below the neurological level have a muscle grade less than 3

29
Q

n the ASIA impairment scale what does D indicate?

A

incomplete - motor function is preserved below the neurological level and at least half of key muscles below the neurological level have a muscle grade of 3 or more

30
Q

on the ASIA impairment scale what does E indicate?

A

normal - motor and sensory function are normal

31
Q

what is spinal shock?

A
  • A state of temporary loss of function in the spinal cord – often lasts 1 day, but can persist up to 1 month post-injury
32
Q

why can the ASIA scale not be used immediately after SCI?

A

in the days or even months following spinal shock means that you cant tell how bad the injury is going to be

33
Q

what symptoms occur after spinal shock fades?

A
  • Flaccid paralysis below the lesion (due to removal of descending/motor input) (replaced by spastic paralysis following spinal shock)
  • Loss of tendon reflexes
  • Impaired sympathetic outflow to vascular smooth muscle can cause decreased blood pressure (high cervical injury)
  • Absent sphincter reflexes and tone
34
Q

what similarities are there between effects of SCI and TBI?

A

Lesion:
* Contusion
* Necrosis, apoptosis
* Hemorrhage, oedema, breakdown of the BBB
* Swelling
* Excitotoxicity
* Diffuse axonal injury (DAI)
* Hyperthermia
* Inflammation

Loss of function:
* Local versus global
* Acute versus chronic (Primary versus secondary injury) (spinal shock or later on)

35
Q

what happens following a contusion (compression) injury in the spine?

A

in the instantaneous mins to days after, we see the tissue around the contusion spreading out in a responsive manner, after about a week you are left with a hole in the tissue that will have debris – any hole in the body will be filled with fluid (csf or other types)
Could be myelin debris, dead neruons or any dead glial cells – as tissue goes into chronic stages then it is fully fluid fllled and becomes a strong capsule – we can’t transduce an action potential through fluid – so motor and sensory deficits are goin to sit below this level

36
Q

what happens after traumatic injury when astrocytes become reactive?

A
  • Become hypertrophic
  • Secrete chondroitin sulfate proteoglycans (CSPGs).
  • Increase expression of normal molecules (Ex: Glial fibrillary acidic protein or GFAP)
  • Result = formation of an glial scar.
  • Glial scar + myelin debris = area which growing axons cannot pass through
37
Q

what is a glial scar?

A

a dense limiting border around the SCI lesion core (the lesion core is also known as the fibrotic scar) formed predominately by scar-forming astrocytes after SCI

38
Q

what prevents axonal regrowth after SCI?

A
  • Glial scar (CSPGs) + myelin/cell debris (NOGO-A, MAG) = area which growing axons cannot pass through
  • Inflammatory cells (such as microglia, lymphocytes, macrophages) flood the lesion and release pro-inflammatory cytokines = affect neuronal viability
  • Diffusible inflammatory mediators (nitrous oxide) = affect neuronal excitability

all causing axon/neurons die or degenerate

39
Q

what is wallerian degeneration in the PNS?

what happens in system that regenerates after injury?

A
  1. the axon becomes fragmented at the injury site. Myelin debris is released into lesion site and Schwann cells becomes reactive
  2. Macrophages are recruited to the injury, Schwann cells and macrpohages clear debris
  3. Schwann cells form regeneration tubes (bands of Bunger) and axons sprout and regrow through the tube
40
Q

what are the regeneration tubes called in wallerian degeneration?

A

Bands of Bungner

41
Q

describe the processes that underlie why walleriant degeneration doesnt occur in the CNS?

A

A normal axon undergoes injury
Injury. Fragmentation of distal axon and myelin sheath. Microglia and astrocytes become activated. Inflammation ensues. Macrophages begin to remove debris.
Myelin debris is not completely removed, although oligodendrocytes survive. Glial scar formed. Cell body undergoes chromatolysis, and synaptic terminals retract.
Axons attempt to sprout but Regeneration fails as axonal growth is inhibited by persistent myelin debris and glial scar

42
Q

what is chromatolysis?

A

Chromatolysis is a reactive change that occurs in the cell body of damaged neurons, involving the dispersal and redistribution of Nissl substance (rough endoplasmic reticulum and polyribosomes) in order to meet an increased demand for protein synthesis such as is required to regenerate axons.

43
Q

what is Nissl substance?

A

a basophilic material primarily composed of ribonucleic acid (RNA) and proteins in aggregate with rough endoplasmic reticulum. This substance is involved in protein synthesis and cellular metabolism

absent in the nucleus and axon

44
Q

what happens to the location of Nissl substance after neuron damage

A

it is displaced from being dense and thick within the cell body to ONLY the periphery of cell body
this is called chromatolysis

Neurodegenerative diseases (9 decks)

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