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Spinal Cord Injury Flashcards

1
Q

What is tetraplegia?

A

Paralysis of 4 limbs

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2
Q

What is paraplegia?

A

Paralysis of 2 limbs (lower limbs)

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3
Q

What is pentaplegia?

A

Respiratory quadriplegia - high level or injury, affects also the head and neck (fifth extremity)

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4
Q

What is cord concussion?

A

Results in temporary disruption of cord-mediated functions, short duration.

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5
Q

What is cord contusion?

A

Bruising of neural tissue causing swelling and temporary loss of cord-mediated function.

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6
Q

What is cord compression?

A

Pressure on the cord causing ischemia to tissues, requires decompression to prevent permanent cord damage

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7
Q

What is cord laceration?

A

Tearing of neural tissues, may be reversible if damage is minimal; may result in loss of cord-mediated functions if spinal tracts are disrupted

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8
Q

What is cord transection?

A

Severing of spinal cord; permanent loss of function

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9
Q

What is hemorrhage? (a spinal cord injury)

A

Bleeding into neural tissue due to blood vessel damage; usually no major loss of function

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10
Q

What are three classifications of spinal cord injuries? (3 ways to classify)

A

Mechanism of injury

Skeletal and neurological level of injury

Completeness of the degree of injury

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11
Q

What is a hyperextension spinal cord injury?

A

Hyperextension of the cervical spine ruptures anterior ligaments?

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12
Q

What is a flexion spinal cord injury?

A

Flexion injury of the cervical spine ruptures posterior ligaments.

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13
Q

What is a compression spinal cord injury? (compression fracture)

A

Compression fractures crush the vertebrae and force bony fragments into spinal canal.

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14
Q

What is a rotation spinal cord injury?

A

Flexion-rotation injury of the cervical spine often caused tearing of ligaments that support the spine.

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15
Q

What are four mechanisms of spinal cord injury?

A

Flexion
Hyperextension
Rotation

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16
Q

What are two levels of spinal cord injury?

A

Skeletal

Neurological

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17
Q

What is the skeletal level of injury?

A

Vertebral level where vertebral bones and ligament damage is the most extensive.

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18
Q

What is the neurological level of spinal cord injury?

A

Lowest segment of the spinal cord; bilateral sensory and motor function are normal.

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19
Q

How is the degree of spinal cord injury classified?

A

Complete or incomplete injury

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20
Q

What is a compete spinal cord injury? (Degree of injury)

A

ASIA grade A

Total loss of sensory and motor function below level of injury

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21
Q

What is an incomplete spinal cord injury? (Degree of injury)

A

ASIA grades B-D

Mixed loss of motor and sensory function.

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22
Q

What determines the degree of loss of motor and sensory function in an incomplete spinal cord injury?

A

Degree of loss depends on level of injury and specific nerve tracts damaged.

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23
Q

What are the 6 syndromes associated with incomplete spinal cord injury?

A 
Anterior cord syndrome
Central cord syndrome
Brown-Sequard syndrome
Conus Medullaris & Cauda Equing syndromes
Posterior Cord syndrome
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24
Q

What is the most common mechanism of injury that causes anterior cord syndrome?

A

Vertebral injury: Often flexion
Spinal cord injury: Direct injury, compression or vascular
Damage to anterior spinal artery

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25
Which pathways are disrupted in an anterior cord syndrome?
Ventral and lateral corticospinal motor tracts. Ventral and lateral spinothalamic sensory tracts Spinal cerebellar tract
26
What are the clinical manifestations of anterior cord syndrome?
Motor paralysis greater in lower extremities. Loss of pain and temperature sensation below level of injury. Position, vibration, and touch remain intact (posterior cord intact).
27
What is the prognosis for anterior cord syndrome?
Poor. | 10% neurological recovery
28
What is the mechanism of injury in central cord syndrome?
Vertebral injury: Hyperextension injury (often older adults) Spinal cord injury: Contusion/lesion in the central portion of the spinal cord
29
Which motor/sensory pathways are are disrupted in central cord syndrome?
Centrally located nerve tracts innervating upper extremities are disrupted.
30
What are the clinical manifestations of central cord syndrome?
Greater motor/sensory deficits in upper limbs than lower limbs. Bowel and bladder control is preserved.
31
What is the prognosis for central cord syndrome?
Good 75% recovery All young and 50% elderly will regain ambulatory function. Most patients do not recover fine motor.
32
What are the most common mechanisms of injury in Brown-Sequard syndrome?
Vertebral injury: Usually penetrating injury (stabbing, gunshot) Spinal cord injury: Damage to lateral half of spinal cord (hemisection)
33
Which motor/sensory pathways are disrupted in Brown-Sequard syndrome?
Ipsilateral motor, proprioception and sense of vibration loss. Contralateral loss of pain and temperature below level of injury.
34
What is the prognosis for Brown-Sequard syndrome?
Very good | 90% recovery of bowel and bladder function and ambulation
35
What is the most common mechanism of injury for Conus-medullaris-cauda equine injury?
Vertebral: Fracture Dislocation Compression Spinal Cord: Compression, contusion, or laceration of conus and sacral spinal nerve roots.
36
Which motor/sensory pathways are disrupted in Conus-medullaris-cauda equite injury?
Lower motor neuron disruption
37
What are clinical manifestations of Conus-medullaris-cauda equine injury?
``` Motor and sensory impairment Bowel and bladder dysfunction Sexual dysfunction Neurologic deficits vary (dependent on area of lesion) ```
38
What are the most common mechanisms of injury in Posterior cord syndrome?
Vertebral: Compression Hyperextension Spinal cord: Compression or damage to posterior spinal artery
39
Waht are the clinical manifestations of Posterior cord syndrome?
Loss of posterior function - proprioception, deep touch and vibration sensation lost.
40
What is the presentation of an upper motor neuron injury?
Spasticity as the reflex arc is untouched and can complete its circuit. In this situation, the Upper motor neurons are unable to temper the responses and spasticity is seen
41
What is the presentation of a lower motor neuron injury?
Flaccidity as the reflex arc is broken before it contacts the spinal cord
42
What is the pathophysiology of a primary spinal cord injury?
Physical disruption of axons Maximal deficit is observed immediately Neurologic injury that occurs at the time of the initial trauma or mechanical injury
43
What is the pathophysiology of a secondary spinal cord injury?
Ischemia, electrolyte imbalance and inflammatory response Begins immediately, may extend to days Mechanical re-injury Release of endogenous substances at the injury site
44
How many people experience spinal shock after a spinal cord injury?
50% of people
45
What is spinal shock? (manifestations)
Complete, temporary loss of motor, sensory, reflex and autonomic function.
46
When does spinal shock occur, and how long does it last?
Occurs immediately after injury. | Usually lasts 48 hours, but can last weeks.
47
What is neurogenic shock? (manifestations)
Temporary loss/disruption of autonomic nervous system below level of injury.
48
When does neurogenic shock occur? (which injuries)
Occurs with cervical or upper thoracic injuries (above T6)
49
When does neurogenic shock occur, and how long does it last?
Occurs soon after the injury. | Can last 3 days to 3 weeks
50
Which has a poorer prognosis/is more unstable, spinal shock or neurogenic shock?
Neurogenic shock
51
What are the characteristics of spinal shock?
Characteristics below level of injury. Decreased reflexes. Loss of sensation. Flaccid paralysis.
52
What are the characteristics of neurogenic shock?
Characteristics at T5 of above. Hypotension Bradycardia Inability to sweat (dry, warm skin)
53
What cellular changes occur within the first few minutes after a spinal cord injury?
Microscopic hemorrhage in central grey matter, vasospasm, hypotension, loss of autoregulation
54
What cellular changes occur within 2 hours of spinal cord injury?
Edema on white matter, impaired microcirculation of spinal cord.
55
What cellular changes occur within 4 hours of spinal cord injury?
Disruption of myelin, axonal degeneration, endothelial cell ischemia
56
What cellular changes occur within 24 hours of spinal cord injury?
Necrosis - 70% of cross section of spinal cord
57
What cellular changes occur within the first few days after spinal cord injury?
Progressive axonal degeneration, cavitation and coagulation necrosis at the site.
58
What cellular changes occur within 3 to 4 weeks after spinal cord injury?
Traumatized cord replaced by acellular collagenous scar tissue
59
What are the priorities of care in spinal cord injury?
``` Prehospital resuscitation ER resuscitation Definitive care/operative care Critical care phase Rehabilitation phase ```
60
What occurs during the prehospital resuscitation?
Communication with EMS is key
61
What occurs during the ER resuscitation?
Primary survey/resuscitation | Secondary survey
62
What are two types of definitive care?
Surgical | Non-surgical
63
What is surgical definitive care? (what does it achieve)
Stabilizes, realigns, and decompresses the spinal column.
64
How is surgical definitive care achieved? (How is stabilization, realignment, and decompression achieved, which procedures are done?)
Laminectomy with fusion Harrington Rods Spinal fusion
65
What is the focus of non-surgical definitive care?
Focus is on stabilization and realignment of injured spine
66
How is stabilization and realignment of injured spine achieved through non-surgical definitive care?
Cervical traction (ex. Halo) Immobilization of the neck in neutral position (ex. Halo vest) Brace tongs - i.e. Gardner Wells
67
When can autonomic dysreflexia occur?
Can occur anytime after resolution of spinal shock
68
What is autonomic dysreflexia?
An acute episode of exaggerated sympathetic response to a noxious stimuli below the level of injury.
69
What causes autonomic dysreflexia?
Results from a lack of control from higher brain centers.
70
What level of the spinal cord injury (which vertebrae level) is associated with autonomic dysreflexia?
Associated with those with T6 or higher injury. | -Those with lower injury usually have enough sympathetic outflow to control visceral reflexes.
71
What occurs during autonomic dysreflexia? (step by step)
1. Full bladder or stimulus from bowel (or other noxious stimuli) 2. Afferent stimulus 3. Massive sympathetic response 4. Widespread vasoconstriction 5. Hypertension 6. Baroreceptors in blood vessels detect hypertensive crisis - signal brain 7a. Heart rate slowed 7b. Descending inhibitory signals blocked at spinal cord injury

Nursing 304 (12 decks)

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