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Year 2 C&M Clinical Symposia > Spinal Cord Injury > Flashcards

Spinal Cord Injury Flashcards

1
Q

What is the difference between an upper motor neurone injury and a lower motor neurone injury?

A

Upper motor neurone injury - any injury to the brain, brain stem, cerebellum or spinal cord
Lower motor neurone injury - any injury to any peripheral nerves (including the cranial nerves)

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2
Q

What is a cauda equine injury?

A

A disruption to the nerve roots that lie within the spinal column

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3
Q

Is an injury to the cauda equina an upper or lower motor neurone injury?

A

Lower motor neurone injury

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4
Q

The incidence of spinal cord injury is low (10-15/million/year), why does the prevalence remain relatively high (40,000 in UK)?

A

Spinal cord injuries often affect younger people, who have many years to live following injury

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5
Q

What is the ratio of males to females affected by spinal cord injury?

A

4 males: 1 female

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6
Q

What kind of age distribution does spinal cord injury show?

A

Bimodal
Peak in 20-29: traumatic accidents
Peak in 50-59: Falls, degenerative spinal cord injury

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7
Q

On which 2 days of the week do 40% of spinal cord injuries occur?

A

Saturday and Sunday (also higher on Thursday and Friday)

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8
Q

What is the first stage of the surgical sieve in deciding the type of spinal cord injury?

A

Congenital or acquired

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9
Q

What are the 2 questions to be answered in diagnosis of a spinal cord injury?

A

1) What is the lesion - surgical sieve

2) Where is the lesion - functional neuroanatomy

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10
Q

Name the 4 main congenital causes of spinal cord injury?

A

1) Spina bifida
2) Birth trauma
3) Congenital spinal anomaly
4) Spinal muscular atrophy

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11
Q

What are the 9 aspects aquired causes in the surgical sieve in diagnosing spinal cord injury?

A

1) Trauma
2) Infection
3) Inflammatory
4) Tumour (benign or malignant)
5) Vascular
6) Metabolic (not normally applicable to spinal cord injury)
7) Degenerative
8) Idiopathic
9) Iatrogenic

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12
Q

What are the 5 main causes of acquired spinal cord injury (in order)?

A

1) Vehicle crashes
2) Bacterial abscesses
3) Inflammatory conditions (such as MS)
4) Secondary malignant tumours
5) Degeneration

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13
Q

What is the main inflammatory cause of acquired spinal cord injury?

A

MS

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14
Q

What is myelitis?

A

Inflammation of the spinal cord

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15
Q

What fracture can commonly lead to damage of the spinal cord?

A

Crush fracture of the vertebra

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16
Q

When determining the level of spinal cord injury, what 2 things are examined?

A

1) Dermatomes

2) Myotomes

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17
Q

What is the difference between tetraplegia and paraplegia?

A

Tetraplegia - caused by a cervical lesion (C1-T1)

Paraplegia - caused by a thoracic lesion (T2-L5)

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18
Q

If a person had a spinal cord lesion with most function preserved in upper limbs but a small loss of function in hands, would this be tetraplegia or paraplegia?

A

paraplegia - if any loss of function at all in upper limb then it is termed paraplegia

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19
Q

How are dermatomes and myotomes assessed?

A

1) Manual muscles testing

2) Sensory testing for light tough and pin prick sensations

20
Q

What scale is used to help diagnose spinal cord injury?

A

American Spinal Cord Association Impairment Scale

21
Q

What are the 4 categories of the ASCA Impairment Scale?

A

A (complete)
B (Incomplete)
C (Incomplete)
D (Incomplete)

22
Q

What does A(complete) on the ASCA Impairment scale indicate?

A

No motor or sensory function is preserved in S5 (S5 is taken as the lowest of all spinal cord groups - responsible for sensation and movement of the anal canal)

23
Q

What does B(incomplete) on the ASCA Impairment scale indicate?

A

Sensory but not motor function is preserved below the neurological level affected by the lesion to S5

24
Q

What does C (incomplete) on the ASCA Impairment scale indicate?

A

Motor function preserved, and more than half of the key muscles below the neurological level have a muscle grade less than 3

25
Q

What does a muscle grade of 3 refer to?

A

Power against gravity

26
Q

What does D(incomplete) on the ASCA Impairment scale indicate?

A

Motor function preserved, and atleast half of the key muscles below the neurological level have a muscle grade of 3 or more

27
Q

What are the 2 types of descending motor tracts in the spinal cord?

A

1) Lateral corticospinal

2) Anterior corticospinal

28
Q

What are the 3 types of ascending sensory tracts in the spinal cord?

A

1) Dorsal columns
2) Anterolateral spinothalamic
3) Spinocerebellar

29
Q

Where and how do the descending lateral and anterior corticospinal tracts in the spinal cord originate?

A

1) Descending fibres from the motor cortex in the brain
2) ~90% of these fibres dessucate at the pyramids and continue as the lateral corticospinal tracts on the contralateral side
3) The other 10% do not decussate at the pyramids and continue as the anterior corticospinal tracts on the ipsilateral side

30
Q

What are the 4 classifications of spinal cord injury in terms of the area damaged?

A

1) Anterior cord
2) Posterior cord
3) Central cord
4) Brown-sequard syndrome (whole one half of cord damaged)

31
Q

Central cord injuries are typically seen when?

A

In older people with degenerative spinal cord disease who fall

32
Q

Anterior cord injuries are typically associated with what?

A

Vascular events

33
Q

Posterior spinal cord injuries are typically associated with what?

A

Dives onto the head - eg. dives into empty pools

34
Q

What are the 4 main outcomes that need to be considered in spinal cord injury?

A

1) Mobility outcome
2) Life expectancy
3) Acute complications
4) Chronic complications

35
Q

How does the ASCA scale correlate with mobility outcome?

A

A (complete) - 1%
B (incomplete) - 35%
C (incomplete) - 75%
D (incomplete) - 100%

36
Q

How does age of injury affect life expectancy following injury?

A

Younger you are - the lesser reduced your life expectancy

80 - average of 2.5 years

37
Q

What are the most common associated injuries with a spinal cord injury?

A

1) Head injuries
2) Chest injuries
3) Abdominal injuries
4) Limb injuries

38
Q

Excessive vagal stimulation is a complication which can occur in which type of spinal cord injures?

A

Lesions above T6 and spinal shock (loss of parasympathetic control)

39
Q

When does excessive vagal stimulation occur in spinal cord injuries, what does it lead to and how can it be prevented?

A

Stimulation by intubation or suctioning
Get an overwhelming vagal output - leading to bradycardia and asystole (loss of heart beat)
Can be prevented by giving atropine prior to intubation or suctioning

40
Q

Autonomic dysreflexia is a complication which can occur in which kinds of spinal cord injuries?

A

Lesions above T6 in established patients

41
Q

How does autonomic dysreflexia present, what is it precipitated by and how can it be treated?

A

Presents with headache, hypertension and facial flushing
Precipitated by bladder distension, constipation, skin, soft tissue and bony injuries (pain stimulation)
Treated by relieving cause and fast acting anti-hypertensives

42
Q

What are the 3 main kinds of acute complications in spinal cord injury?

A

1) UTIs - stones, progressing to renal failure
2) Resp infection - progressing to resp failure
3) Pressure sores - osteomyelitis, amyloid, neoplastic change

43
Q

What are the 5 main aspects to management of an acute spinal cord injury?

A

1) Bed rest/positioning/skull traction
2) Prevent further damage to spinal cord
3) Skin care
4) Bladder and bowel care
5) Prevention of thromboembolic and GI complications

44
Q

What are the 4 aspects to management of a chronic spinal cord injury?

A

1) Appropriate skin care
2) Bladder and bowel care
3) Prevention of thromboembolic complications
4) Remembering patient will present differently with problems - ie. peritonitis presentation will be different

45
Q

What are the 2 main categories of chronic complications of spinal cord injuries?

A

1) Progressive neurological decline - syringomyelia, neuronal ‘drop out’, pain and spasticity
2) Rheumatological complications - degenerative joint disease, hetertropic ossification

46
Q

What is hetertropic ossification?

A

Deposition of calcium in muscles

47
Q

How is spinal cord injury treatment changing/ hopes ofr the future? 3

A

1) Spinal cord regeneration
2) Assistive technology - eg. harnesses enabling patients to walk unaided
3) New rehabilitation techniques - direct stimulation of muscles to achieve lost movements, robotic arms and games to re learn arm function

Year 2 C&M Clinical Symposia (21 decks)

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