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08 Neuro > Spinal Cord Injury > Flashcards

Spinal Cord Injury Flashcards

1
Q

clinical effects of complete spinal cord injury

A

all voluntary movement and sensory gone

reflex function in all segments are suspeded

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2
Q

definition of level of injury

A

most caudal segment with normal sensation and muscle strength of 3/5 or better with the level immediately above 5/5

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3
Q

complete vs incomplete lesion

A

complete: no preservation of any motor or sensory function
incomplete: any residual motor or sensory function more than 3 segments below the level of injury

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4
Q

signs of incomplete cord injury

A

any sensation or voluntary movement in LE
sacral sparing (anus sensation, perineum, voluntary anal contraction)
preservation of sacral reflexes not counted

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5
Q

what is spinal shock

A

profound loss of all spinal reflexes below level of injury + complete paralysis and anesthesia

NOT THE SAME AS COMPLETE CORD INJURY

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6
Q

presentation of spinal shock

A

flaccid paralysis
areflexia
hypotonic paralysis of bowel and bladder
hypotension, anhidrosis, flushed warm peripheral skin
hypotension without compensatory tachy (if high cervical lesion)

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7
Q

triad of neurogenic shock

A

hypotension
bradycardia
hypothermia

more common in injuries above t6 due to secondary disruption of sympathetic outflow from t1-l2

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8
Q

t/f less complete lesions and slow developing lesions result in little to no spinal shock

A

true

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9
Q

mechanisms of spinal cord injury

A

vertical compression
hyperflexion
rotational
hyperextension

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10
Q

characteristics of vertical compression

A

creates axial node on vertebra –> vertebral body is compressed –> burst fracture

usually in lumbar

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11
Q

characteristics of hyperreflexion injury

A

causes wedge fractures and stretched interspinous ligaments

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12
Q

characteristics of rotational injuries

A

shearing injury that causes fracture

results in tearing of posterior ligamentous structures and displacement of vertebrae

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13
Q

characteristics of hyperextension injury

A

causes a disruption in the anterior longitudinal ligament or buckling of ligamentum flavum into spinal canal

can rupture intervertebral discs

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14
Q

asia impairment scale

A

table 4

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15
Q

pathology in acute paraplegia syndrome

A

squeezing or shearing in spinal cord –> destruction of gray and white matter + hemorrhage –> traumatic necrosis

healing –> gliotic focus or cavitation + hemosiderin and iron
in months/years: progressive cavitation happens (traumatic syringomyelia or fluid build up) –> delayed central or incomplete transverse cord syndrome

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16
Q

t/f in most traumatic lesions, the lateral parts suffer greater injury

A

false, the central parts

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17
Q

features of cord injury in c1-c3

A

vasomotor and respiratory collapse = ventilator support

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18
Q

features of cord injury in c4-c5

A

quadriplegia/tetraplegia with preserved respiratory function

complete paralysis below the neck

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19
Q

features of cord injury in c5-c6

A

sparing of shoulder muscles with partial paralysis of arm and hands
loss of biceps and brachioradialis reflexes
paralysis of lower body

20
Q

features of cord injury in c7 and c8

A

c7: biceps sparing, loss of triceps reflex
c8: triceps sparing, paralyzed fingers and wrist flexion

21
Q

high vs low cervical cord injury

A

table 6

22
Q

features of t6 injury

A

paraplegia (xiphoid process)

23
Q

features of t9 injury

A

paralysis of lower abdominal muscles
loss of superficial abdominal reflexes
(+) beevor sign

24
Q

high vs low thoracic cord injury

A

high: spares UE, impaired breathing, ileus, paraplegia
low: spares abdominal muscles, normal breathing,

25
Q

lumbar cord injury (l1)

A

paraplegia

26
Q

incomplete injuries of spinal cord

A

central cord syndrome
anterior spinal cord syndrome (anterior 2/3)
posterior spinal cord syndrome (posterior column)
brown sequard syndrome (hemisection)

27
Q

most common type of incomplete spinal cord injury

A

central cord syndrome - symmetrical incomplete quadriparesis, disproportionately affecting ue

28
Q

tracts affected in central cord syndrome

A

cervical corticospinal

cervical lateral spinothalamic

29
Q

pathophysio of ccs

A

fall forward and hit chin = hyperextension
usually with preexisting narrowing of spinal canal

spinal cord rubs against disc osteophyte = anterior compression
inward buckling of ligamentum flavum = posterior compression

30
Q

clinical presentation of ccs

A

loss of pain and temperature in the distribution level of the injury
expansion of lesion = weakness at level of sensory loss

31
Q

syringomyelia in ccs

A

fluid filled cavitation in the cord

  • loss of pain and temp sensation (cape-like sensory loss)
  • suspended sensory loss
  • weakness of muscles in arms with atrophy and hyporeflexia
  • later: cst involvement with brisk reflexes in legs, spasticity and weakness
32
Q

etiology of syringomyelia in ccs

A

trauma

chiari type 1 malformation

33
Q

clinical presentation of syringomyelia

A

central cord syndrome (arms weaker than legs)
dissociated sensory loss
areflexic weakness in ue

34
Q

management of syringomyelia

A

syringo-subarachnoid shut

35
Q

another type of lesion that can have similar presentation with ccs

A

intramedullary tumor

36
Q

clinical presentation of anterior spinal cord syndrome

A

bilateral muscle weakness (cst)
bilateral loss of pain and temp sensation (stt)
urinary incontinence (descending autonomic tracts)
posterior column sparing

37
Q

etiology of ascs

A

anterior spinal artery infarction 2/3 (thromboembolism, trauma, vertebral burst fracture)
intervertebral disc herniation
radiation myelopathy
spinal metastasis (fracture or sc compression)
cervical spine injury w/ wedge and burst fractures (bone compressing)

38
Q

progression of symptoms in ascs

A 
back pain
numbness of limbs
difficulty walking
urinary urgency
paralysis
39
Q

least favorable prognosis in all of syndromes

A

ascs

preservation of some sensory or motor function below the level of injury are good prognostic factors

40
Q

clinical presentation of posterior spinal cord syndrome

A

loss of proprioception and vibration sense
no weakness
bladder dysfunction

41
Q

clinical presentation of brown sequard syndrome

A

ipsilateral: weakness, lmn symptoms at level, umn symptoms below, loss of proprioception, vibrationi, light touch, and tactile sense
contralateral findings: loss of pain and temperature sensation

42
Q

etiology of brown sequard syndrome

A

knife or bullet
ms
tumor

43
Q

t/f cauda equina syndrome is part of incomplete cord injuries

A

false

44
Q

clinical presentation of cauda equina syndrome

A

radicular pain in sciatic distribution that worsens with coughing or sneezing
severe radicular sensory deficits in legs and saddle area
lmn deficit: flaccid paresis of le with areflexia, urinary and fecal incontinence, impaired sex

45
Q

clincial presentation of conus syndrome

A 
detrusor areflexia with urinary retention and overflow incontinence
fecal incontinence
impotence
saddle anesthesia
loss of anal reflex
46
Q

management for conus syndrome

A

open surgery to remove disk that comes out

47
Q

clinical presentation of poliomyelitis

A

lower motor neuron weakness (invasion of anterior horn cells)
flaccid paralysis
atrophy
areflexia

08 Neuro (24 decks)

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