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Neuro II > Spinal Cord Injury: Pathophysiology > Flashcards

Spinal Cord Injury: Pathophysiology Flashcards

1
Q

What areas of the c-spine are most often involved in SCI, and what are some common MOIs?

A
  • C4-C7
  • Flexion + rotation (#1)
  • Vertical loading
  • Extension + rotation
  • Lateral flexion
  • Hyperextension
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2
Q

What areas of the T-spine are most often involved in SCI, and what are some common MOIs?

A
  • T12-L1
  • Flexion or vertical compression

Less likely to be traumatic

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3
Q

What areas of the L-spine are most often involved in SCI, and what are some common MOIs?

A
  • L1
  • Flexion

Typically incomplete

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4
Q

Tetraplegia

A
  • Injury c-spine
  • Involvement of all 4 extremities
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5
Q

Paraplegia

A
  • Thoracic or lumbar regions
  • Involved BLE and trunk
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6
Q

Complete SCI

A
  • Absence of sensory and motor function below lesion level (ZPP possible)
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7
Q

Incomplete SCI

A

partial preservation of sensory and motor functions below level of lesion

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8
Q

Who has a better prognosis, complete or incomplete SCI?

A

Incomplete

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9
Q

Define zones of partial preservation

A

Dermatomes and myotomes caudal to the sensory and motor level that remains partially innervated.

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10
Q

Where are the most common sites and types of SCI overall?

A
  • Cervical (C5-C7) and thoracolumbar junctures (T12-L1)
  • Incomplete tetraplegia
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11
Q

Which occurs more frequently, complete or incomplete paraplegia?

A

Both about equal

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12
Q

What is the primary goal of acute medical management of SCI?

A

Stabilize the spine

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13
Q

How is the primary medical management of SCI achieved?

A
  • Surgery (reduction or compression)
  • External support devices
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14
Q

How does methylprednisone impact prognosis for incomplete SCI?

A

enhances return of some function below spinal level

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15
Q

How does methylprednisone impact prognosis for complete SCI?

A

increases changes of return of function of last preserved spinal level (1 level)

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16
Q

What is the function of methylprednisone for SCI?

A
  • Stabilizes cell membranes
  • Decreases inflammation
  • Increased nerve impulse generation
  • Improved blood flow to damaged area
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17
Q

When does methylprednisone need to be administered for SCI?

A

3-8 hours post-injury

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18
Q

What are some pathological secondary sequalae of SCI that the medical team must work
diligently to manage?

A
  • Ischemia (direct and indirect)
  • Edema
  • Demyelination and necrosis of axons progressing to scar tissue
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19
Q

What is spinal shock?

A

temporary phenomenon with injuries T6 and above in which cord in its entirety ceases to function below lesion.

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20
Q

What characteristics are associated with spinal shock?

A
  • Absent: spinal reflexes, voluntary motor control, sensory function, autonomic control below level of lesion
  • Initially increased BP then drop in BP, HR, hypothermia, venous stasis
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21
Q

When does spinal shock resolve?

A

Within 24 hours to several days post injury

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22
Q

How doe we know spinal shock is starting to resolve?

A

Sacral/anal reflexes begin to return.

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23
Q

What is autonomic dysreflexia?

A

over-activity of the autonomic nervous system with damage to T6 or above.

24
Q

What causes autonomic dysreflexia?

A

irritating stimulus introduced to body below level of spinal cord injury.

25
Q

What is the most common cause of autonomic dysreflexia?

A

Full bladder
(Others: wound/pressure sores, burns, ingrown toenails, kinked clothing, foreign object pressing against skin)

26
Q

What are the symptoms of autonomic dysreflexia?

A
  • Pounding HA
  • Goose bumps
  • Sweating above level of injury
  • Bradycardia
  • Skin blotching
27
Q

If you think your patient is demonstrating autonomic dysreflexia, what should you do?

A
  • Sit them up! (DO NOT LIE DOWN)
  • Perform pressure relief
  • Check catheter
  • Check clothing
  • Check skin
  • Initiate emergency response if not resolved within 10 min
28
Q

What are the more dangerous sequelae of autonomic dysreflexia?

A

Seizures, LOC, death

29
Q

Why do we see impaired thermoregulation with some SCI?

A
  • loss of sympathetic output (damage to T6 or above)

Body lost the ability to control blood vessel responses that conserve or dissipate heat or shiver.

30
Q

What are the signs and symptoms of hyperthermia?

A
  • Skin feels hot and appears flushed
  • Feeling weak
  • Dizziness
  • HA
  • Visual disturbance
  • Nausea
  • Tachycardia
  • Weak or irregular HR
31
Q

What are the signs and symptoms of hypothermia?

A
  • Shivering
  • Exhaustion/drowsiness
  • Confusion
  • Slurred Speech
32
Q

What types of patient education are critical with impaired thermoregulation?

A

Weather appropriate clothing

33
Q

Is spasticity common with this patient population?

A

~65% of SCI patients will experience spasticity, more common with c-lesions

34
Q

Why do we see pulmonary dysfunction with this patient population?

A

If injury is in T10 or above the diaphrahm/accessory muscles lost control

35
Q

With what level can we expect normal ventilatory and respiratory function?

A

T10 and below

36
Q

How does bladder dysfunction differ between SCI levels?

A

level of SCI determines type of dysfunction

37
Q

Bladder dysfunction when lesion is above conus medullaris/sacral dysfunction.

A
  • Spastic/hypereflexic bladder
  • Voiding is involuntary and incomplete
38
Q

Bladder dysfunction when lesion is at or below conus medullaris/sacral dysfunction.

A
  • Bladder overfills and overdistends
  • Overflow and stress incontinence may occur
39
Q

Bladder dysfunction management

A
  • Exeternal collection devices (catheter)
  • Intermittent catheterizations
  • medicaion
  • Surgery: suprapubic catheter, bladder augmentation
40
Q

How does bowel dysfunction differ between SCI levels?

A
  • Above S2: spastic/reflex bowel (excremet is involuntary and incomplete)
  • S2-S4: flaccid/areflexive bowel (bowel overfills and over-distends)
41
Q

How do we manage bowel dysfunction?

A

Reflex bowel programs: digital stem programs and bowel suppositories

42
Q

Why is bowel and bladder dysfunction so important with SCI care?

A

Can lead to autonomic dysreflexia

Bowel is 2nd most common cause!

43
Q

What are the symptoms of bladder and bowel dysfunction?

A
  • Fever
  • Chillds
  • Nausea
  • HA
  • Increased spasticity
  • Autonomic dysreflexia
  • Dark or bloody urine
44
Q

What are some of the more common presentations of sexual dysfunction post SCI for
males?

A

Erectile capcity spared with UMN lesion, but fertility can be impacted.

45
Q

What are some of the more common presentations of sexual dysfunction post SCI for
females?

A

Menstruation and fertility more likley to be spared (pregnancy is high risk)

46
Q

What are common issues seen regarding blood pressure management post SCI?

A
  • T6 and up: persistent bradycardia, excessive peripheral vascular dilation
  • Orthostasis common with all level (increased risk T6 and up)
47
Q

Why are BP issue common with SCI?

A
  • Cardiovascular dysfunction
  • lack of efficient muscle tone
  • Loss of sympathetic vasoconstriction response in LE’s = venous pooling
48
Q

How can we intervene with irregular BP? What is most effective?

A
  • Abdominal binder
  • TED stocking
  • ACE wraps
  • Monitor fluid intake
49
Q

What types of pain do we see with SCI?

A

Neuropathic and orthopedic

50
Q

What are common causes of SCI pain?

A
  • irritation and damage to neural elements
  • Mechanical trauma
  • Surgical interventions
  • Poor handling/positioning
51
Q

What might a patient with neuropathic pain complain of?

A
  • Pooly localized
  • Numbness, tingling, burning, shooting, aching pain + visceral disomfort below level of injury
52
Q

What can exaggerate neuropathic pain in SCI?

A
  • Noxious stimuli
  • UTI
  • Spasticity
  • Bowel impaction
  • Cigarette smoking
53
Q

SCI orthopedic pain is common in what regions?

A

SHOULDER, low back

54
Q

Why do we see an increased risk for osteoporosis and renal calculi post SCI?

A
  • Changes in calcium metabolism (Decreased BMD > Ca to blood > kidneys)
  • Decreased weight bearing
55
Q
A

Neuro II (17 decks)

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