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Semester 5 PMNM Exam 8 > Spinal Cord Injury (Tighe - PA) > Flashcards

Spinal Cord Injury (Tighe - PA) Flashcards

1
Q

4 mechanisms of SC trauma

A

transection
compression
contusion
vascular injury

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2
Q

what happens in transection

A

glia are disrupted and SC tissue is torn

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3
Q

causes of transection 4

A

penetrating trauma
blunt trauma
bony fragments
disc herniation

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4
Q

cauases of compression injury to SC

A

violent shaking or direct blow

temporary loss of function

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5
Q

describe contusion injury to SC

A
  • glial tissue and SC surface are intact

- may have loss of grey and white matter which creates a cavity with white matter rim at periphery

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6
Q

when do you suspect vascular injury to the SC?

A

suspect vascular injury if discrepancy between clinical neurological deficit and level of spinal injury

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7
Q

examples of vascular injury

A
  • lower cervical dislocation compresses vertebral arteries

- thrombosis, decreased BF through anterior spinal artery

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8
Q

anterior spinal artery originates where

A

originates at C1 from both vertebral arteries and appears as C1 or C2 loclization

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9
Q

primary injury

A

damage that occurs immediately at time of injury due to forces such as compression, contusion, shear injury, penetrating, GSW
- spared tissues and axons may remain and are important in recovery

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10
Q

secondary injury

A

begins within minutes of injury and evolves over hours, includes: ischemia, hypoxia, inflammation, edema, electrolyte distrubances

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11
Q

describe blood flow changes from secondary inuury

A

occur within 2 hours following injury. Decreased SC BF, rapid swelling at level of injury, pressure on SC increases, ischemia, necrosis

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12
Q

edema occurs when

A

within hours after injury (secondary injury), occurs first at injury site and spreads to adjacent and distal segments

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13
Q

immediate treatment of SCI includes what

A

manual immobilzation of C spine with hands, followed by using a C collar. next do CAB’s and full spinal immobiliztion

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14
Q

what happens if the c collar is too short or too tall?

A

too short = cervical flexion

too tall = cervical extension

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15
Q

consults with what 5 areas

A

neurosurgeon, orthopedist, trauma specialist, general surgeon, others as needed

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16
Q

describe the cord in a complete cord injury

A

the cord is transected in a complete cord injury

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17
Q

complete cord injury: sensory and motor fxn

A

complete loss of sensory and motor function occurs below the level of the lesion in a complete cord injury

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18
Q

complete cord injury what ASIA grade

A

A

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19
Q

acute stages of complete cord injury (symptoms)

A

absent reflexes, no response to plantar stimulation, flaccid muscle tone, priapism, urinary retention and bladder distension

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20
Q

ASIA grade for incomplete cord injury

A

grades B-D

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21
Q

motor and sensory fxn in incomplete cord injury

A

partial loss of sensory and motor function below the level of the lesion in an incomplete cord injury

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22
Q

incomplete cord injury caused by

A

contusion, edema, bony fragments

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23
Q

causes of complete cord injury

A

transection of cord, severe compression, or extensive vascular dysfunction

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24
Q

which is more preserved in an incomplete cord injury, sensation or motor fxn

A

sensation preserved more than motor fxn becuase sensory tracts are more peripheral and less vulnerable

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25
incomplete cord injury - motor and sensation
various degrees of muscle motor fxn and sensation in dermatomes
26
the more incomplete the injury, the more what recovery?
the more incomplete the injury, the more favorable the potential for recovery, especially on initial eval and 72 hrs to 1 week after injury
27
ASIA impairment scale
A = complete B - D = incomplete E = normal
28
how are deficits determined in SCI?
deficits determined by neurological levels/lesions
29
tetraplegia aka and what levels
aka quadriplegia | levels C1-C8
30
paraplegia levels?
thoracic, lumbar, or sacral segments
31
define central cord syndrome
damage to the central part of the SC. the peripheral fibers are not affected
32
central cord syndrome caused by
cervical hyperextension with pre-existing cervical spondylosis
33
central cord syndrome: more severe motor impariment where
more severe motor impairment in UE than LE!
34
bladder and sensory issues with central cord syndrome
bladder dysfunction and variable sensory loss below the injury level
35
pain and temp - central cord
loss of pain and temp sensation at the site of injury and surrounding dermatomes due to crossing of spinothalamic fibers - "suspended sensory loss"
36
central cord pain and temp above and below
intact pain and temp at dermatomes above and below the injury
37
central cord vibration and proprioception
vibration and proprioception often spared in central cord syndrome
38
cause of anterior cord syndrome
loss of blood supply from anterior spinal artery, which supplies 2/3 of SC
39
anterior cord syndrome - tactile, position and vibratory sense
are normal.
40
what is lost in anterior cord syndrome
urinary incontinence
41
anterior cord syndrome is caused by what 4 things
flexion injuries, IVD herniation, SC infarction, radiation myelopathy
42
how common is posterior cord syndrome
rare
43
how is the CST impacted in posterior cord syndrome
acute: weakness, flaccidity, hyporeflexia chronic: hypertonia, hyperreflexia
44
characteristics of posterior cord syndrome
loss of proprioception causing wide-based gait ataxia, loss of vibratory sense, bladder dysfunction, paresthesias
45
causes of posterior cord syndrome
MS, friedreich ataxia, tumors, cervical spondylotic myelopathy, tabes dorsalis
46
characteristics of brown-sequard
unilateral involvement | weakness, loss of vibration/proprioception on the same side of the lesion and loss of pain/temp on opposite side
47
causes of brown-sequard
knife, GSW, demyelination, disc herniation, infarction, infection, tumor
48
conus medullaris syndrome is what type of injury
sacral cord injury
49
conus medullaris syndrome is associated with what lesion
L2 - often affects conus medullaris
50
characteristics of conus medullaris syndrome
early, prominent sphincter dysfxn, flaccid paralysis of rectum/bladder, impotence, saddle anesthesia, leg muscle weakness
51
causes of conus medullaris syndrome
disc herniation, spinal fracture, tumors
52
Cauda equina syndrome is due to injury of what
injury of lumbosacral nerve roots
53
what happens in cauda equina
loss of fxn of 2+ of the 18 nerve roots in the cauda equine - usually central lumbar disc herniation
54
characteristics of cauda equine syndrome
LBP w/ radiating pain, PF weakness, bladder and rectal sphincter paralysis (S3-5), sensory loss in dermatomes, saddle anesthesia
55
T/F cauda equine is a medical emergency
true. refer to neurosurgery
56
what is syringomyelia
a clinical syndrome that affects 2% of paraplegics
57
most common site for syringomyelia
thoracic area
58
causes of syringomyelia
cystic cavitation and gliosis of SC (cyst develops and grows down the SC)
59
when does syringomyelia usually occur
within 4-9 years post trauma but can develop up to 30 years after initial lesion
60
S/S of syringomyelia
initial sharp pain, LMN dysfxn, sensory loss, Horner's syndrome - changes difficult to assess - below site of injury
61
3 sx of Horner's
ipsilateral ptosis, miosis, anhydrosis
62
syringomyelia may have what additional s/s
spasms, reflex changes, phantom sensations, sexual dyscn, spasticity, weakness, HA, loss of b/b, sensation loss in hands
63
neurapraxia
- transient neuro deficits - transient tetraplegia from axial loading (diving into pool) - athletic injuries - sudden decrease in AP diameter of SC = compression - seen w/ hypertext and hyperflex
64
What is spinal shock
transient (!!!!) physiological deficit of cord fxn below the level of injury - complete loss of all neuro fxn but will resolve
65
s/s of spinal shock
- initial: tachycardia, htn due to release of catecholamines - then bradycardia and hypotension - paralysis, b/b dysfxn, priapism
66
what is neurogenic shock
- severe autonomic dysfxn - interruption of SNS - usually does not occur with injury below T6!!
67
neurogenic shock does not usually occur with an injury below which level
T6
68
KEY s/s of neurogenic shock (3)
- HYPOTENSION - BRADYCARDIA - PERIPHERAL VASODILATION
69
other s/s of neurogenic shock
hypothermia, priapism, decreased shivering/sweating below injury, loss of body temp control below injury, b/b incontinence
70
what do you consider with a spinal injury below T6?
consider hemorrhagic until proven otherwise.
71
goals of sCI
- mean arterial BP at least 90 - fluids bu tdon't overhydrate - pressors to maintain BP - maintain BS to SC
72
what occurs with BP in injuries above T6
baseline BP is reduced as well as HR (50-60bpm) | don't push too hard with exercise
73
orthostiatic hypotension | eval
eval BP and PULSE in supine, sitting and standing
74
orthostatic hypotension dx if
decreased SBP > 20 and/or | decreased DBP > 10
75
autonomic dysreflexia occurs in SC injuries above what level
T6
76
what is autonomic dysreflexia
an uninhibited sympathetic response to stimuli. leads to diffuse VC and HTN. compensate via PSNS above the lesion w/ bradycardia and VD but not enough to compensate
77
when does autonomic dysreflexia usually occur
in first month/first year after injury | 20-70% of SCI w/ lesions above T6 will have it
78
autonomic dysreflexia - medical emergency?
YES!
79
stimuli of autonomic dysreflexia
bladder distension, bowel impaction, pressure sores, bone frx, sexual activity, labor, menstrual cramps
80
S/S of autonomic dysreflexia
``` headache - pounding! HTN 20-40 above normal for pt brady or tachy diaphoresis above injury flushing blurred vision anxiety nausea ```
81
complications of autonomic dysreflexia
HTN, HTN crisis, bradycardia, cardiac arrest, IC hemorrhage, seizures
82
management of autonomic dysreflexia
check BP, sit pt up, remove tight clothing, search for cause - often from crimped catheter. could also be UTI or fecal impaction
83
management of autonomic dysreflexia
meds to lower BP
84
keys of autonomic dysreflexia
recognition and avoidance of causative stimuli
85
CAD
mortality great in SCI w/ lesions above T5. may have atypical s.s of cardiac ischemia such as autonomic dysreflexia and changes in spasticity
86
CAD
Cardiac arrhythmias Acute cervical SCI - due to Excess vagal tone Hypoxia, hypotension, fluid and electrolyte imbalances Less frequently seen in chronic SCI Complete cervical SCI – ongoing risk for cardiac arrest
87
Ventilatory fxn
respiratory muscles not working in cervical and high thoracic SCI
88
issues with ventilation
dyspnea, decreased ex tolerance, impaired cough, lung secretions, increased risk of pneumonia
89
DVT
common early complication from lack of mvmt. prevent via exercise, turning in bed, drugs, ted hose, etc
90
what to do if suspect DVT
stop mobilization, report findings, Doppler ultrasound, D dimer blood test
91
why do SCI pt's have difficulty with temp regulation
due to disruption of autonomic pathways
92
who are most vulnerable for lack of temp regulation
SCI T6 and above
93
impaired cooling mechanism (temp regulation) -
loss of SNS: insensate skin and reduced sweating autonomic dysfxn below lesion, loss of muscle pump increased metabolic heat
94
T/F those with SCI have difficulty cooling themselves
true (or heating)
95
definition of hypothermia (body temp must be)
core body temp below 95 F (35 C)
96
2 types of bladder dysfxn
spastic and flaccid. goal is bladder volume less than 500 ml to avoid distention

Semester 5 PMNM Exam 8 (2 decks)

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