Spinal cord injury Flashcards
Spinal cord injury definition
A disruption to the spinal cord (usually due to trauma)
Cauda equina injury definition
Disruption to the nerve roots that lie within the spinal column
Epidemiology of spinal cord injury
40k in UK
Males 4:1 females
Age: bimodal distribution
Congenital spinal cord injuries
Birth trauma
Spina bifida
Congenital spinal anomaly
Spinal muscular atrophy
Cervical lesion between C1 and T1 =
Tetraplegia
Thoracic lesion between T2 and L5
Paraplegia
AISI impairment scale levels
A (complete)
B (incomplete)
C (incomplete)
D (incomplete)
AISI - A
No motor or sensory function is preserved in S5
AISI - B
Sensory but not motor function is preserved below the neurological level to S5
AISI - C
Motor function preserved, and more than half of key muscles below the neurological level have a muscle grade less than 3
AISI - D
Motor function preserved, and at least half of key muscles below the neurological level have a muscle grade of 3 or more
Descending motor tracts are where?
Lateral corticospinal
Anterior corticospinal
Ascending sensory tracts are where?
Dorsal columns
Anterolateral spinothalamic
Spinocerebellar
How is cord injury divided?
Ant. (blood supply lesions)
Post. (dive into empty swimming pools)
Central
Brown-Sequard Syndrome
Mobility prognosis for AISI types
A - 1%
B - 35%
C - 75%
D - 100%
Excessive vagal stimulation
Lesions above T6 and spinal shock -> loss of parasym control
Overwhelming vagal output - bradycardia + asystole
Prevent by avoiding vagal stimulation -> atropine prior to intubation, suctioning
Autonomic dysreflexia
Lesions above T6 in established patients
Precipitated by bladder distension, constipation, skin, soft tissue, bony injuries.
Presents with headache, hypertension, facial flushing, relieve cause, antihypertensives
Acute complications
UTI
Resp failure
Pressure sores - osteomyelitis, amyloid, neoplastic change
Management of acute spinal cord injury
Bed rest/positioning/skull traction Prevent further damage to spinal cord Skin care Bladder and bowel care Prevention of thromboembolic and GI complications
Management of chronic spinal cord injury
Listen to patient Appropriate skin care Bladder and bowel care Prevention of thromboembolic complications Different presentations
Chronic complications
Progressive neurological declines via syringomelia, neuronal ‘drop-out,’ pain and spasticity.
Rheumatological complications -> degen joint disease, heterotopic ossification
