Spinal Cord Injury Medicine

Question 1

Most common SCI

Answer 1

Teraplegia most common (C5)

Paraplegia (T12)

Question 2

Most common cause of SCI

Answer 2

Vehicular

Question 3

Primary vs secondayr cascade of SCI

Answer 3

Primary - acute hemorrhage and ischemia

Secondary - shearing of cell membranes and axons…disruption of BBB…immune cell migration and myelin degradation

Question 4

1st step in tx of SCI

Answer 4

Regonition of the spinal cord injry

Question 5

Central cord syndrome

Answer 5

Most common incomplete SCI

UE>LE weakness
Bladder dysfunction
Older
DUe to hyperextension

Recovery is LE, bladder, UE and then hand if possible

Question 6

Brown-Sequard syndrome

Answer 6

Ipsilateral loss of sensation at level
Ipsilateral flaccid paralysis at the level of the lesin
Ipsilateral loss of vibration, fine touch, and position sense below lesion
Contralateral loss of pain and temp below lesion

Question 7

Brown Sequard other things

Answer 7

Most from stab or GSW
Recovery in ipsilateral proximal extensors and then distal flexors
Most regain bowel and bladder contro

Question 8

Anterior cord syndrome

Answer 8

Could be from hernatiation
Varabilable loss of motor and pinprick sensation with sparing of light touch, proprioception and deep pressure on both sides

Question 9

Epiconus lesions

Answer 9

Fractue T12 and above
Affects lower lumbar roots rupplying muscles of the lower part of leg and foot

UMN with spasticity, spastic bowel, and bladder dysfunction

Question 10

Conus medullaris lesions

Answer 10

Fracture at T12-L1

LMN, hypotonic reflexes in bowl and bladder

Question 11

Cauda equnia syndrome

Answer 11

Below L2
Lower extremity weakness
Hypotonic reflexes with bowel and bladder dysfunction
High risk of pain

Question 12

Incomplete paraplegia vs. complete recovery

Answer 12

In - motor longer than sensory…76% community ambulators

Complete - same rate…above T9 - no LE recovery…T9-L2 - hip and knee but not foot…5% ambulators

Question 13

Incomplete tetraplegia vs. complete recovery

Answer 13

Incomplete - motor longer than sensory…46% ambulators

COmplete - same rate…rarely get lower extreimity motor functin o

Question 14

Respiratory complications

Answer 14

Any at or above C3-C5 because supplies the phrenic nerves to diaphragm
May need ventilator

Question 15

Pneumonia

Answer 15

Leading cause of mortality in SCIs

At or above T8 levels

Question 16

Thromboembolism

Answer 16

Due to venous stasis secondary to loss of muscles pumping
Could lead to PE if not treated
LMWH used

Question 17

Autonomic dysrefleia

Answer 17

Above T6
Loss of autonomic regulation due to disruption of sympathetic response

Orthostatic hypotension
Temp dysregulation
Autonomic dysreflexia - increased BP, headache, decreased pulse due to painful stimuli and is emergency

Question 18

Spasticity

Answer 18

Increased muscle tone and spasms as a result of injury to CNS
Velocity dependent

Associate with pain, contracture, increase care giver time, interfere with hygeine

Question 19

Pressure injury

Answer 19

Wounds occur over bony prominences that result in tissue death due to areas of unrelieved pressure

Question 20

Neuropathic pain

Answer 20

Dorsal horn spinothalamic tract
Consequence of ongoing activity in the periphery…develop increased background activity with larger receptive fields and increased responses

Present at and below

Question 21

MSK pain

Answer 21

Due to overuse syndrome in upper levels in paraplegia

Use NSAIDs

Question 22

Flaccid bladder

Answer 22

Below T10 and LMN alterations
Use catheter
Increased UTI risk
Poor med response

Question 23

Spastic bladder

Answer 23

Above T10
Catheter
Increased UTI risk

Question 24

UMN reflexive bowel

Answer 24

ABove T10
Need laxatives
Best if 30 minutes upright after meal

Question 25

LMN areflexive bowel

Answer 25

Below T10
Flaccid
Avoid stool softeners and increase fibers

Question 26

Dual diagnosis

Answer 26

30% of paitnets with cervicl spinal cord injury also have TBI