Test 3 Spinal Cord Injury (CNS, Spinal Cord) Flashcards
What is the pathophysiology of Spinal Cord Injury (SCI)?
Spinal Cord Injury Patho:
- Hemorrhage
- Metabolic (Inflammatory Processes)
- Cellular changes
- Vasoconstriction/Thrombosis
- Vasospasms/Edema
- Decreased spinal cord blood flow
- Spinal cord ischemia and hypoxia
What is a complete injury?
Total loss of sensory and motor function below level of injury
What are the 2 types of Complete injuries?
2 Types of Complete Injuries:
- **Tetraplegia (Quadriplegia)
- Cervical area down
- All 4 extremities
- **Paraplegia
- From waist down
Complete Injury
What are the characteristics of tetraplegia?
Tetraplegia:
Characteristics:
-Paralysis of both arms and legs
Injuries in the cervical region result in quadriplegia –paralysis/paresis of all 4 extremities and trunk.
Complete Injury
With a tetraplegic, where did the injury occur on the spine?
Complete Injury: Tetraplegia
*** Injury to cervical region C1-C8 **
What is the goal with a tetraplegic patient (Complete Injury)?
Why is this goal important?
Goal: Airway Management
- Paralysis of the diaphragm if injury above C3.
- An injury at C4 or above poses a great risk for impaired spontaneous ventilation because of the the involvement of the phrenic nerve (originates in the neck and passed down between the lung and heart to reach the diaphragm).
Complete Injury
What are the characteristics of paraplegia?
Paraplegia:
Characteristics: Paralysis of both LEGS
Waist down
Complete Injury
With a paraplegic, where did the injury occur on the spine?
Complete Injury: Paraplegic
Injury to the thoracolumbar region T2-L1
Complete Injury: Paraplegia
How are arms affects?
What is required?
Is respiratory compromised?
Complete Injury: Paraplegia
- May have full use of arms
- May require wheelchair or have some limited use lower extremities
- May have some respiratory compromise (varying degrees of intercostals and abdominal muscle paralysis
If a person has COPD or a respiratory problem, can respiratory be compromised?
Yes. If person all ready CODP or respiratory problem, can still have respiratory compromise b/c don’t have as much abdominal muscle use.
What is an Incomplete Injury?
Incomplete Injury:
Mixed loss of voluntary motor activity and sensation below level of injury.
What are the 4 Types of Incomplete Injury?
4 Types of Incomplete Injury:
- Brown-Sequard Syndrome
- Central Cord Syndrome
- Anterior Cord Syndrome
- Posterior Cord Syndrome
Incomplete Injury:
What is Brown-Sequard Syndrome?
Brown–Sequard Syndrome
-Transection/Damage of one side of spinal cord
Incomplete Injury:
Brown-Sequard Syndrome
What type of injury can cause this?
Incomplete Injury:
Brown-Sequard Syndrome
Patient stabbed in the back with an icepick or small knife. The smallness of the object is the cause of this injury.
What clinical manifestations occur with Brown-Sequard Syndrome below the injured site cord:
- Motor? Which side?
- Sensation? Which side?
Below injured site cord…
-Loss voluntary motor function
SAME SIDE AS INJURY
-Loss of pain, temperature, & sensation
opposite side of injury
Incomplete Injury:
What is Central Cord Syndrome?
What is it associated with?
Incomplete Injury:
Central Cord Syndrome
- Hematoma formation in center of cervical cord
- Associated with cervical flexion/extension injury
Incomplete Injury:
What are the clinical manifestations of Central Cord Syndrome?
Motor? Side effected?
Sensory?
What else is effected?
Incomplete Injury:
Central Cord Syndrome
Motor weakness
-Upper extremities weaker than lower
- Sensory function varies
- Varying degrees bowel and bladder dysfunction
B/c edema is in the middle of the Central cord, it has effect on the ascending and descending tracts.
Incomplete Injury:
What is Anterior Cord Syndrome?
What is it associated with?
Incomplete Injury:
Anterior Cord Syndrome
- Acute compression of anterior portion of spinal cord
- Associated with flexion injuries or acute herniation of an intervertebral disc
What are the clinical manifestations of Anterior Cord Syndrome?
Motor?
Sensation?
Incomplete Injury:
Anterior Cord Syndrome
- Loss motor function below site of injury
- Loss pain, temperature & CRUDE sensation
Incomplete Injury:
What is Posterior Cord Syndrome?
What is it associated with?
Incomplete Injury:
Posterior Cord Syndrome
-Damage to the posterior column
Not as common, but unique to look at!
-Associated with cervical hyperextension injury
Incomplete Injury:
What are the clinical manifestations of Posterior Cord Syndrome?
Motor?
Sensation?
Incomplete Injury:
Posterior Cord Syndrome
- Loss position sense, vibration, and pressure (May not have ability to walk)
- Motor function, pain and temperature sensation intact.
What will be part of the assessment with a spinal cord injury?
What is an important unique assessment to pay attention to and why?
- Pain at level of injury
- Numbness/weakness, loss of sensation below level of injury
- Complete/incomplete
- Address Respiratory distress
- Alterations in bowel and bladder function
-Alterations in temperature control
They tend to take on the temp of the room b/c cannot vasodilate like normal.
What is spinal shock?
How long does it last? (Think about football player)
- Spinal shock is Initial period of flaccid paralysis and loss of sensation and reflexes.
- Lasts between 48 hours to several weeks
What assessment findings occur with spinal shock?
When does this occur?
What else happens?
When does this occur?
Spinal Shock:
- Complete loss of all reflex activity below level of injury:
- **Loss of sensation
- **Flaccid paralysis
- **Absent reflexes
- Occur shortly after injury
- **Muscle spasms
- Hyper-reflexic and spastic
- Occurs within days to weeks