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Neuromuscular Pathology (Midterm) > Traumatic Spinal Cord Injury > Flashcards

Traumatic Spinal Cord Injury Flashcards

1
Q

most frequent causes of traumatic SCI:

A
  • MVA (38%)
  • Falls (30.5%)
  • Acts of violence (primarily gun shot wounds; stabbings)
  • Sports/Recreational injuries 9%
  • Other
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2
Q

Partial or complete paralysis of all 4 extremities & trunk,
including respiratory muscles, and results from lesions of cervical cord. Approx 56% of patients with SCI:

A

Tetraplegia

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3
Q

Partial or complete paralysis of all or part of trunk & both LE’s and results from lesions of thoracic or lumbar cord or cauda equina. Approx 43% of patients with SCI

A

Paraplegia

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4
Q

results from lesions of thoracic or lumbar cord or cauda equina

A

paraplegia

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5
Q

Results from lesions of cervical cord

A

tetraplegia

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6
Q

Which is currently the most frequent SCI?

Followed by?

A
  • Incomplete tetraplegia
  • Followed by incomplete paraplegia
  • Complete paraplegia
  • Complete tetraplegia
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7
Q

ASIA

A

American Spinal Injury Association

  • developed in 1992
  • revised periodicaly
  • improve accuracy and reliability of SCI examination
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8
Q

What is NEUROLOGICAL LEVEL (NLI), MOTOR LEVEL, SENSORY KEVEL and SKELETAL LEVEL of injury?

A
  • NL: Refers to the most caudal segment of (3 or greater) muscle function strength, provided there is normal (intact) sensory and motor function rostrally respectively
  • SKL: the greatest vertebral damage is found on a radigraph.
  • ML: grade of at least 3/5 AND key muscle functions above that level are intact (grade of
    5/5)
  • Sensory level = most caudal, intact dermatome for both pinprick and light touch sensation
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9
Q

How is a complete SCI determined?

A

Determined by anal sensation and voluntary external anal sphincter contraction

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10
Q

Collection of muscle fibers innervated by the motor axons within each segmental nerve root

A

MYOTOME

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11
Q

preservation of some sensory or motor function below the neurological level of the lesion including sensory &/or motor function at S4 & S5

A

incomplete SCI

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12
Q

(S4 and S5) no sensory or motor function in the lowest sacral segments

A

complete SCI

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13
Q

complete SCI caused by?

A
  • complete transection of cord
  • severe compression of cord
  • extensive vascular impairment
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14
Q

incomplete SCI injury cause by?

A
  • contusions: pressure on cord from displaced bone &/or soft tissue or from swelling within spinal canal
  • partial transection of cord
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15
Q

Zone of partial preservation (ZPP):

A
  • Determined in complete SCI only
  • Intact motor &/or sensory function below the neurological level but NO S4 & S5 motor or sensory function
  • Lowest dermatome or myotome on each side with some preservation/innervation
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16
Q

ASIA Impairment Scale:

A
  • A = Complete: No motor or sensory function preserved in the lowest sacral segments
  • B = sensory incomplete: Sensory but not motor function preserved in the lowest sacral segments
  • C = motor incomplete: Motor function present below the injury but more than half key muscles are <3/5
  • D = motor incomplete: Motor function present below the injury but at least half key muscles are >3/5
  • E = normal: Motor and sensory function normal, only assigned if initial deficit is present
  • F Some patterns of spinal cord injury have special names.
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17
Q

Incomplete (SCI) Clinical Syndromes:

A
  • Brown-Sequard Syndrome
  • Anterior Cord syndrome
  • Central Cord Syndrome
  • Posterior Cord Syndrome
  • Cauda Equina Injuries
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18
Q

Which incomplete SCI is usually caused by stab wounds?

A

Brown-Sequard Syndrome

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19
Q

What is Brown-Sequard Syndrome?

A

Hemisection of spinal cord

20
Q

Clinical features of Brown-Sequard Syndrome

A
  1. Ipsilateral: paralysis, loss of sensation in dermatome segment corresponding to level of lesion, abnormal reflexes, clonus, positive babinski, loss of proprioception, kinesthesia, and vibration
  2. Contralateral loss of pain & temperature several dermatomes below level of the lesion
21
Q

What is anterior cord syndrome?

Clinical Feautures?

A
  • Flexion injuries of CS
  • Damage to SC or ASA
  • usually due to compression of anterior cord: fracture, dislocation, cervical disc protrusion
  • Clinical features:
    • loss of motor function below level of lesion
    • loss of pain & temperature below level of the lesion
22
Q

What is Central Cord Syndrome?

A
  • hyperextension injuries of cervical spine
  • could be congenital or degenerative narrowing of spinal canal: compressive forces lead to hemorrhage & edema
  • UE’s more involved than LE’s
  • varying degress of sensory loss
  • motor loss more severe
  • complete preservation of sacral tracts
  • can ambulate
23
Q

What is posterior cord syndrome?

A
  • rare
  • posterior columns affected
  • loss of proprioception, two-point discrimination,
    graphesthesia, sterognosis below level of the lesion
  • wide-based steppage gait pattern typical
  • preservation of motor, pain & light touch
24
Q

What is cauda equina injuries?

A
  • Usually incomplete
  • LMN’s lesion
  • potential to regenerate, but reinnervation is not common
25
Q

4 most common types of forces in SCI

A
  • flexion
  • compression
  • hyperextension
  • flexion-rotation
26
Q

some areas of spine more susceptible to injury:

A
  • cervical area = C5 - C7
  • thoracolumbar area = T12 - L2
27
Q

least common mechanism of injury in SCI

A

Distraction: traction force in cervical spine where head is pulled away from body

28
Q

True or false:

shearing forces do not create SCI

A

false

29
Q

Which is the most common mechanism of SCI?

A

flexion

30
Q

what type of fx is associated with flexion SCI?

A
  • *wedge fracture** of anterior vertebral body
  • high % occur from C4-C7 & T12-L2*
31
Q

what is the casue of compression SCI?

A
  • vertical or axial blow to head (diving, falling objects, surfing)
  • closely associated with flexion injuries
32
Q

what is the casue of flexion-rotation SCI?

A
  • posterior to anterior force directed at rotated spine ( rear end collision with passenger rotated toward driver)
33
Q

what is the casue of hyperextension SCI?

A
  • strong posterior force (rear end collision)
  • falls with chin striking stationary object (often seen in elderly population)
34
Q

Clinical Manifestations of SCI:

A
  1. Spinal shock: Period of areflexia
  2. Motor & sensory impairments: partial or complete bellow
  3. Autonomic Dysreflexia: elevation of BP, medical emergency
  4. Postural Hypotension
  5. Impaired temperature control: autonomic dysfunction
  6. Pulmonary impairment: tetraplegia, C1-C3 phrenic nerve
  7. Spasticity: bellow level of lesion
  8. Bladder & bowel dysfunction
  9. Sexual dysfunction
  10. Secondary impairments & complications: pressure sores, DVT
35
Q

What is heterotopic (ectopic) ossification?

A

Abnormal bone growth in soft tissue below level of lesion

36
Q

gradual increase in spasticity seen during __________
post SCI

A

1st 6 months

37
Q

C1-C3 SCI may cause:

A

severe to mild impairment of respiratory function due to paralysis of respiratory muscles (phrenic nerve)

38
Q

SCI autonomic (sympathetic) dysfunction can result in

A
  • loss of internal thermoregulatory response
    • compensatory diaphoresis above level of lesion
  • no vaso dilatation/constriction is response to heat/cold
39
Q

Incomplete SCI autonomic (sympathetic) dysfunction can result in:

A

spotty areas of localized sweating below level of lesion

40
Q

Pathological autonomic reflex resulting in elevation of blood pressure

A

Autonomic Dysreflexia (Hyperreflexia)

medical emergency

41
Q

what is the most common cause of Autonomic Dysreflexia?

A

bladder distention (urinary retention)

42
Q

Most commont symptoms of autonomic dysreflexia:

A
  • headache
  • profuse sweating
  • flushing
  • hypertension (elevated BP)

(slide 47 of SCI for more)

43
Q

Intervention in autonomic dysreflexia:

A
  • 1st check catheter and tubing
  • position pt in sitting position (lower BP)
  • look for irritating stimuli: tight clothing etc.
  • obtain medical assistance
44
Q

what is the 1st indicator of spinal shock

A

+ bulbocavernosus reflex

45
Q

Period of areflexia immediately following SCI, absence of all reflex activity, flaccidity & loss of sensation below level of lesion, lasts for several hours to several weeks and usually subsides within 24 hours.

A

Spinal shock

46
Q

SCI postural hypotension intervention includes:

A
  • elevation of head from the bed
  • tilt table
  • compressive agents
  • abdominal binder
  • drug therapy
47
Q

which is the most frequent neurological category of SCI?

A

incomplete tetraplegia

Neuromuscular Pathology (Midterm) (9 decks)

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