spinal trauma/ICU

Question 1

Indications for acute MRI in spine trauma?

Answer 1

• Incomplete SCI with normal alignment - soft tissue injury?
• Neurological deterioration - also applies after closed reduction
• Neurological deficits not explained by the CT
  eg: - fracture level different from deficits shown - no bony injury id.

BUT OBS! Think arterial dissection too.

Question 2

What is a Brown Sequard syndrome?

Question 3

What is a central cord syndrome?

Question 4

complete cervical cord lesions

Question 5

Is acute surgery indicated for central cord syndrome?

Answer 5

That is disputed. IF done, it should be emergent.

Question 6

What are signs of central cord syndrome?

Answer 6

ventral to posterior:
* Anterior commissure lesion - from the lesion and below bilateral- loss of pain, temp,crude touch and pressure.
* LMN signs only at the level of injury (hyporeflex and flaccid paralysis, fasciculations)
* UMN injury mostly of medial part of the lateral cortical tract - upper limb rigid paralysis and hyperreflexion from below the lesion.
* depending on level, hornes sign might be seen. (deschending autonomic)

Question 7

signs of UMN injury in the later phase?

Answer 7

spastic paralysis and hyperreflexes

Question 8

Signs of LMN injury in the later phase?

Answer 8

flaccid paralysis and hyporeflexes.

Question 9

Signs of medullary lesion in the acute phase?

Question 10

What group of patients get SCI much more often than the general pop even after small trauma and injuries more common in the lower cervical spine?

Answer 10

Ankylosing spondylosis pt. (bamboo spine)

Question 11

What is crucial about the blood pressure after SCI?

Answer 11

systolic blood pressure should be kept over 90.

Question 11

According to Greenberg there are a few obstacles to closed reduction of frx/dislocation after SCI, but otherwise it is recomended early. What are the ostacles?

Answer 11

• Not just a cervical injury but also a more rostral.
• Pt that cannot be examined during the reduction - MRI needed first
• Presence of significant herniated disc. - ACDF is needed fisrt!

Question 11

What is recomended MAP during the first 7 days after SCI?

Answer 11

85-90

Question 12

What are the chances of improval by surgery after complete spinal cord lesion?

Answer 12

According to greenberg, noone has demonstrated clinical improvement.

Question 13

Surgery has proven to give good results for all incomplete SCI except for one type. WHich?

Answer 13

central cord syndrome.

Question 14

What does abscence of bulbocavernous reflex suggest?

Answer 14

Presence of spinal shock. It may not be possible to declare a suprasacral SCI as complete because there might be spinal shock which could transiently suppress spinal cord function.

Question 15

What is bulbocavernous reflex?

Answer 15

COntraction of anal sphincter in responce to squeezing the glans penis.

Question 16

There are 2 meanings of “spinal chock”. They are completely different. Explain.

Answer 16

1. Hypotension= follows spinal cord injury (usually 80mmHg(too low))
2. Transient loss of all neurologic functions including segmental and polysynaptic reflex activity and autonomic function. Below the level of injury. (and because this is inflammation, sometimes a little above - animal studies)

Question 17

How is a (neurologic)spinal chock presenting clinically

Answer 17

Flaccid paralysis and areflexia.

Question 18

Duration of (neurological) spinal shock?

Answer 18

72h-2 weeks. (months can be)

Question 19

HOw does one recoginise that the (neurologically) spinal shoch is over?

Answer 19

• SPasticity below injury -UMN injury.
• Return of bulbocavernous reflex.