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Nursing 304 > Spinal Cord Injury > Flashcards

Spinal Cord Injury Flashcards

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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
Q

Which pathways are disrupted in an anterior cord syndrome?

A

Ventral and lateral corticospinal motor tracts.
Ventral and lateral spinothalamic sensory tracts
Spinal cerebellar tract

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26
Q

What are the clinical manifestations of anterior cord syndrome?

A

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).

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27
Q

What is the prognosis for anterior cord syndrome?

A

Poor.

10% neurological recovery

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28
Q

What is the mechanism of injury in central cord syndrome?

A

Vertebral injury:
Hyperextension injury
(often older adults)

Spinal cord injury:
Contusion/lesion in the central portion of the spinal cord

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29
Q

Which motor/sensory pathways are are disrupted in central cord syndrome?

A

Centrally located nerve tracts innervating upper extremities are disrupted.

30
Q

What are the clinical manifestations of central cord syndrome?

A

Greater motor/sensory deficits in upper limbs than lower limbs.
Bowel and bladder control is preserved.

31
Q

What is the prognosis for central cord syndrome?

A

Good
75% recovery
All young and 50% elderly will regain ambulatory function.
Most patients do not recover fine motor.

32
Q

What are the most common mechanisms of injury in Brown-Sequard syndrome?

A

Vertebral injury:
Usually penetrating injury (stabbing, gunshot)

Spinal cord injury:
Damage to lateral half of spinal cord (hemisection)

33
Q

Which motor/sensory pathways are disrupted in Brown-Sequard syndrome?

A

Ipsilateral motor, proprioception and sense of vibration loss.
Contralateral loss of pain and temperature below level of injury.

34
Q

What is the prognosis for Brown-Sequard syndrome?

A

Very good

90% recovery of bowel and bladder function and ambulation

35
Q

What is the most common mechanism of injury for Conus-medullaris-cauda equine injury?

A

Vertebral:
Fracture
Dislocation
Compression

Spinal Cord:
Compression, contusion, or laceration of conus and sacral spinal nerve roots.

36
Q

Which motor/sensory pathways are disrupted in Conus-medullaris-cauda equite injury?

A

Lower motor neuron disruption

37
Q

What are clinical manifestations of Conus-medullaris-cauda equine injury?

A 
Motor and sensory impairment
Bowel and bladder dysfunction
Sexual dysfunction
Neurologic deficits vary
(dependent on area of lesion)
38
Q

What are the most common mechanisms of injury in Posterior cord syndrome?

A

Vertebral:
Compression
Hyperextension

Spinal cord:
Compression or damage to posterior spinal artery

39
Q

Waht are the clinical manifestations of Posterior cord syndrome?

A

Loss of posterior function - proprioception, deep touch and vibration sensation lost.

40
Q

What is the presentation of an upper motor neuron injury?

A

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
Q

What is the presentation of a lower motor neuron injury?

A

Flaccidity as the reflex arc is broken before it contacts the spinal cord

42
Q

What is the pathophysiology of a primary spinal cord injury?

A

Physical disruption of axons
Maximal deficit is observed immediately
Neurologic injury that occurs at the time of the initial trauma or mechanical injury

43
Q

What is the pathophysiology of a secondary spinal cord injury?

A

Ischemia, electrolyte imbalance and inflammatory response
Begins immediately, may extend to days
Mechanical re-injury
Release of endogenous substances at the injury site

44
Q

How many people experience spinal shock after a spinal cord injury?

A

50% of people

45
Q

What is spinal shock? (manifestations)

A

Complete, temporary loss of motor, sensory, reflex and autonomic function.

46
Q

When does spinal shock occur, and how long does it last?

A

Occurs immediately after injury.

Usually lasts 48 hours, but can last weeks.

47
Q

What is neurogenic shock? (manifestations)

A

Temporary loss/disruption of autonomic nervous system below level of injury.

48
Q

When does neurogenic shock occur? (which injuries)

A

Occurs with cervical or upper thoracic injuries (above T6)

49
Q

When does neurogenic shock occur, and how long does it last?

A

Occurs soon after the injury.

Can last 3 days to 3 weeks

50
Q

Which has a poorer prognosis/is more unstable, spinal shock or neurogenic shock?

A

Neurogenic shock

51
Q

What are the characteristics of spinal shock?

A

Characteristics below level of injury.

Decreased reflexes.
Loss of sensation.
Flaccid paralysis.

52
Q

What are the characteristics of neurogenic shock?

A

Characteristics at T5 of above.

Hypotension
Bradycardia
Inability to sweat (dry, warm skin)

53
Q

What cellular changes occur within the first few minutes after a spinal cord injury?

A

Microscopic hemorrhage in central grey matter, vasospasm, hypotension, loss of autoregulation

54
Q

What cellular changes occur within 2 hours of spinal cord injury?

A

Edema on white matter, impaired microcirculation of spinal cord.

55
Q

What cellular changes occur within 4 hours of spinal cord injury?

A

Disruption of myelin, axonal degeneration, endothelial cell ischemia

56
Q

What cellular changes occur within 24 hours of spinal cord injury?

A

Necrosis - 70% of cross section of spinal cord

57
Q

What cellular changes occur within the first few days after spinal cord injury?

A

Progressive axonal degeneration, cavitation and coagulation necrosis at the site.

58
Q

What cellular changes occur within 3 to 4 weeks after spinal cord injury?

A

Traumatized cord replaced by acellular collagenous scar tissue

59
Q

What are the priorities of care in spinal cord injury?

A 
Prehospital resuscitation
ER resuscitation
Definitive care/operative care
Critical care phase
Rehabilitation phase
60
Q

What occurs during the prehospital resuscitation?

A

Communication with EMS is key

61
Q

What occurs during the ER resuscitation?

A

Primary survey/resuscitation

Secondary survey

62
Q

What are two types of definitive care?

A

Surgical

Non-surgical

63
Q

What is surgical definitive care? (what does it achieve)

A

Stabilizes, realigns, and decompresses the spinal column.

64
Q

How is surgical definitive care achieved? (How is stabilization, realignment, and decompression achieved, which procedures are done?)

A

Laminectomy with fusion
Harrington Rods
Spinal fusion

65
Q

What is the focus of non-surgical definitive care?

A

Focus is on stabilization and realignment of injured spine

66
Q

How is stabilization and realignment of injured spine achieved through non-surgical definitive care?

A

Cervical traction (ex. Halo)
Immobilization of the neck in neutral position (ex. Halo vest)
Brace tongs - i.e. Gardner Wells

67
Q

When can autonomic dysreflexia occur?

A

Can occur anytime after resolution of spinal shock

68
Q

What is autonomic dysreflexia?

A

An acute episode of exaggerated sympathetic response to a noxious stimuli below the level of injury.

69
Q

What causes autonomic dysreflexia?

A

Results from a lack of control from higher brain centers.

70
Q

What level of the spinal cord injury (which vertebrae level) is associated with autonomic dysreflexia?

A

Associated with those with T6 or higher injury.

-Those with lower injury usually have enough sympathetic outflow to control visceral reflexes.

71
Q

What occurs during autonomic dysreflexia? (step by step)

A
  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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