Spinal injury Flashcards
describe the life expectancies for different spinal cord injuries
Severe tetraplegia - life expectancy reduced by 1/3
Otherwise normal
What is the incidence of different spinal cord injuries
was 50:50 between paraplegic and tetraplegic but now 75:50 tetra:para
Which diagnostic test is best used for spinal cord injury
MRI
What is a halo brace?
A brace used on a patient with multiple cervical fractures
Which region of the spinal cord is most commonly injured?
Cervical region
Which spinal tracts cross over at the medula oblongata?
- posterior column and lateral corticospinal tracts
Which spinal tracts cross in the spinal cord?
- spinothalamic tract
What is quadriplegia?
injury in the cervical region in which all 4 extemities are affected
What is paraplegia?
Injury in the thoracic, lumbar or sacral segments in which 2 extremities are affected
What is tetraplegia?
AKA - quadriplegia
patients have paralysis in the cervical region from C1-7
What is a complete spinal cord injury?
Lesion at a specific site from the injury and no information can pass
What is an incomplete spinal cord injury?
Variable amount of movement and sensation below the site of injury
What are the different types of incomplete injuries?
- central cord syndrome
- anterior cord syndrome
- posterior cord syndrome
- brown-sequard syndrome
- cauda equina syndrome
What is central cord syndrome?
type of incomplete spinal injury
- most common
- typicall elderly patients (degenerative changes)
- hyperextension injury
centre of the cord is affected by compression anteriorly by osteophytes and posteriorly by ligamentum flavum
What are the symptoms of central cord syndrome?
Preservation of light touch proprioception and some retainment of sharp/blunt discrimination and hot/cold sensation.
Weak upper limbs but strong lower limbs
What is brown-sequard syndrome?
a type of incomplete spinal injury
- hemi-section of the cord due to penetrating injuries (stab/gunshot)
What are the symptoms of brown-sequard syndrome?
- paralysis on the affected side (corticospinal)
- loss of proprioception and fine discrimination (dorsal columns)
- pain and temperature loss on the opposite side below the lesion (spinothalamic
What is cauda equina syndrome?
a type of incomplete spinal cord injury that is due to bony compression or disc protrusions in the lumbar or sacral region
What are the symptoms of cauda equina syndrome?
non specific symptoms = back pain
- bowel and bladder dysfunction
- leg weakness and numbness
- saddle parasthesia
creates lower motor neuron problems
How do you assess spinal cord injuries?
Clinical examination to determine the extent of the injury and prognosis for recovery
Examines patients power by assessing the myotomes. And voluntary anal contraction.
ASIA scale
Above which spinal segment will an injury cause autonomic dysfunction?
T5
What is spinal shock?
temporary supression of all reflex activity below the level of the injury
occurs immediately after injury at varying intensity and duration
Which reflex sign is the first to appear as spinal shock wears off?
babinski sign
What are the stages of spinal shock?
1- Areflexia/Hyporeflexia
2- Initial reflex return
3- Hyperreflexia (initial)
4- Hyperreflexia, Spasticity
What is neurogenic shock?
The body’s response to the sudden loss of sympathetic control
- distributive shock
- occurs in people who have SCI above T6, which causes more than 50% loss of sympathetic innervation
What are the clinical symptoms of neurogenic shock?
- hypotension
- bradycardia
- hypothermia
How is neurogenic shock treated?
ionotropic support
What is an upper motor neuron lesion?
a lesion of the neural pathway above the anterior horn cell of the spinal cord or motor nuclei of the cranial nerves
What is a lower motor neuron lesion?
Affects nerve fibers travelling from the anterior horn of the spinal cord or the cranial motor nucleu to the relevant muscle
How can an upper motor neuron occur?
damage to the CNS
How can a lower motor neuron occur?
Damage to the nerve roots/peripheral nerve
What are the signs of an upper motor neuron lesion?
- muscle weakness
- increased tone
- increased reflexes
What are the signs of a lower motor neuron lesion?
- muscle weakness and wasting
- reduced tone
- reduced reflexes
- fasciculations
What signs would be present in a lesion between c1 and c5?
UMN signs are present in both upper and lower limbs
What igns would be present in a lesion between T3 and T12
UMN signs present in the lower limbs
upper limbs are normal
What signs would be present in a lesion between T12 and S2?
LMN signs are present in the lower limbs
upper limbs are normal
Describe the effects of autonomic dysreflexia
- T6 and above
normal hypotension an increase in noxious stimuli leads to an increase in sympathetic activity causing hypertension from constricted blood vessels. Normally you get a parasympathetic response to counteract this but this doesn’t happen.
Get headaches and flushed.
At increased risk of stroke if the problem not fixed.
What secondary problems can occur in patients with spinal cord injury?
- bone density needs to be evaluated
- autonomic dysreflexia
- sexual function and fertility
- pain - neuropathic
- bowels
- bladder => hydronephrosis
- pressure sores
- high risk of PTE/DVT
