Spinal Cord Injury Flashcards
define SCI
damage to SC that temporarily/permanently causes changes to its function
differentiate between the types of SCI
traumatic: due to external physical impact resulting in acute damage
non traumatic: acute/chronic disease process generates primary injury
discuss the biological cellular consequences of traumatic SCI
causes cell damage which can trigger complex secondary injury cascade involving death of neurons and glial cells, ischemia and inflammation, this is followed by changes in organisation and structural architecture of SC
What factors increase the risk of mortality of TSCI?
severity, increasing px age, presence of multisystem trauma, higher energy mechanisms
What is happening in SC 0-48hrs after injury?
mechanical trauma initiates secondary injury cascade characterised in acute phase by oedema, haemorrhage, ischemia, inflammatory cells infiltration, release of cytotoxic products, cell death -> necrosis, apoptosis of neurons and glial cells, demyelination
What is happening in SC 2-4days after injury?
subacute phase when further ischemia occurs due to ongoing oedema, vessel thrombosis and vasospasm, persistent inflammatory cell infiltration causes further cell death, cystic microcavities as cells in extracellular architecture of cord are damaged
What is happening in SC 2weeks - 6 months after injury?
intermediate and chronic phases where axons continue to degenerate and astroglial scar matures to become potent inhibitor of regeneration
compare the description of SC # to neuro injury
of SC described by vertebral level, neuro injury described by SC level at which nerve roots emerge
Which SC level injuries can disrupt sympathetic outflow to heart and what symptoms does this cause?
injuries in cervical and high thoracic spine can disrupt symp outflow to heart resulting in bradycardia and decreased cardiac output
clinical manifestations of SCI depend on which two main factors?
level of neuro injury and amount of preserved SC tissue
parasymp-sympathetic imbalance of blood flow to and from heart causes which symptoms from the sympathetic system and parasympathetic system
symp: vasoconstriction, acute HTN
parasymp: increase in outflow above injury, vasodilation, headache, sweating, sinus congestion
define neuro shock
loss of sympathetic innervation of the heart causing imbalance bw parasympathetic and sympathetic stimulation of smooth muscle, SCI above T6, causes organ tissue hypoperfusion, HOTN, brady-> tachycardia, wide pulse pressure
define spinal shock
post SCI, temp state of flaccid paralysis including loss of motor, sensory, autonomic and reflex function at or below LOI
What is the most common imaging used for SCI?
MRI
describe medical management of SCI relating to haemodynamics
maintenance of adequate SC perfusion by avoiding HOTN and supporting MAP, O2 sats >90% and DVT PPX
