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Phase 2 4. Neurology > Spinal injury > Flashcards

Spinal injury Flashcards

1
Q

describe the life expectancies for different spinal cord injuries

A

Severe tetraplegia - life expectancy reduced by 1/3

Otherwise normal

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2
Q

What is the incidence of different spinal cord injuries

A

was 50:50 between paraplegic and tetraplegic but now 75:50 tetra:para

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3
Q

Which diagnostic test is best used for spinal cord injury

A

MRI

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4
Q

What is a halo brace?

A

A brace used on a patient with multiple cervical fractures

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5
Q

Which region of the spinal cord is most commonly injured?

A

Cervical region

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6
Q

Which spinal tracts cross over at the medula oblongata?

A
  • posterior column and lateral corticospinal tracts
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7
Q

Which spinal tracts cross in the spinal cord?

A
  • spinothalamic tract
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8
Q

What is quadriplegia?

A

injury in the cervical region in which all 4 extemities are affected

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9
Q

What is paraplegia?

A

Injury in the thoracic, lumbar or sacral segments in which 2 extremities are affected

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10
Q

What is tetraplegia?

A

AKA - quadriplegia

patients have paralysis in the cervical region from C1-7

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11
Q

What is a complete spinal cord injury?

A

Lesion at a specific site from the injury and no information can pass

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12
Q

What is an incomplete spinal cord injury?

A

Variable amount of movement and sensation below the site of injury

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13
Q

What are the different types of incomplete injuries?

A
  • central cord syndrome
  • anterior cord syndrome
  • posterior cord syndrome
  • brown-sequard syndrome
  • cauda equina syndrome
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14
Q

What is central cord syndrome?

A

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

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15
Q

What are the symptoms of central cord syndrome?

A

Preservation of light touch proprioception and some retainment of sharp/blunt discrimination and hot/cold sensation.

Weak upper limbs but strong lower limbs

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16
Q

What is brown-sequard syndrome?

A

a type of incomplete spinal injury

  • hemi-section of the cord due to penetrating injuries (stab/gunshot)
17
Q

What are the symptoms of brown-sequard syndrome?

A
  • 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
18
Q

What is cauda equina syndrome?

A

a type of incomplete spinal cord injury that is due to bony compression or disc protrusions in the lumbar or sacral region

19
Q

What are the symptoms of cauda equina syndrome?

A

non specific symptoms = back pain

  • bowel and bladder dysfunction
  • leg weakness and numbness
  • saddle parasthesia

creates lower motor neuron problems

20
Q

How do you assess spinal cord injuries?

A

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

21
Q

Above which spinal segment will an injury cause autonomic dysfunction?

A

T5

22
Q

What is spinal shock?

A

temporary supression of all reflex activity below the level of the injury

occurs immediately after injury at varying intensity and duration

23
Q

Which reflex sign is the first to appear as spinal shock wears off?

A

babinski sign

24
Q

What are the stages of spinal shock?

A

1- Areflexia/Hyporeflexia
2- Initial reflex return
3- Hyperreflexia (initial)
4- Hyperreflexia, Spasticity

25
Q

What is neurogenic shock?

A

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
26
Q

What are the clinical symptoms of neurogenic shock?

A
  • hypotension
  • bradycardia
  • hypothermia
27
Q

How is neurogenic shock treated?

A

ionotropic support

28
Q

What is an upper motor neuron lesion?

A

a lesion of the neural pathway above the anterior horn cell of the spinal cord or motor nuclei of the cranial nerves

29
Q

What is a lower motor neuron lesion?

A

Affects nerve fibers travelling from the anterior horn of the spinal cord or the cranial motor nucleu to the relevant muscle

30
Q

How can an upper motor neuron occur?

A

damage to the CNS

31
Q

How can a lower motor neuron occur?

A

Damage to the nerve roots/peripheral nerve

32
Q

What are the signs of an upper motor neuron lesion?

A
  • muscle weakness
  • increased tone
  • increased reflexes
33
Q

What are the signs of a lower motor neuron lesion?

A
  • muscle weakness and wasting
  • reduced tone
  • reduced reflexes
  • fasciculations
34
Q

What signs would be present in a lesion between c1 and c5?

A

UMN signs are present in both upper and lower limbs

35
Q

What igns would be present in a lesion between T3 and T12

A

UMN signs present in the lower limbs

upper limbs are normal

36
Q

What signs would be present in a lesion between T12 and S2?

A

LMN signs are present in the lower limbs

upper limbs are normal

37
Q

Describe the effects of autonomic dysreflexia

A
  • 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.

38
Q

What secondary problems can occur in patients with spinal cord injury?

A
  • bone density needs to be evaluated
  • autonomic dysreflexia
  • sexual function and fertility
  • pain - neuropathic
  • bowels
  • bladder => hydronephrosis
  • pressure sores
  • high risk of PTE/DVT

Phase 2 4. Neurology (29 decks)

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