week 12- spinal trauma

Question 1

Grey matter:

Answer 1

inner region containing nerve cell bodies, dendrites, & non-myelinated axons

Question 2

Vertebral horn:

Answer 2

contains motor neurons

Question 3

Dorsal horn:

Answer 3

interneurons receiving information from sensory neurons

Question 4

Lateral horns:

Answer 4

visceral motor neurons

Question 5

neurogenic shock

Answer 5

• form of distributive shock that occurs with acute SCI. –paralysis below injury- loss of tendon reflexes, and sensation below this level.
• The higher the level of injury, the more serious the effects are.
• main effect loss of sympathetic vasomotor tone, resulting in vasodilation, increased venous capacity and hypotension, prolonged may lead to critical hypotension and bradycardia.
• Additionally, bowel and bladder function are lost This shock may last for hours, days or weeks. If reflex function is returned by arrival at hospital, the neuromuscular changes are likely reversible.

Question 6

Central cord syndrome:

Answer 6

• SCI is predominantly in the central part of the cord, involving the grey or white matter.
• corticospinal (motor) tracts with arm fibres located more centrally, and leg fibres more laterally.
• Therefore, haemorrhage in the central part of the cord compresses the central fibres (arms) more readily than the lateral fibres (legs)
• causing loss of motor function of the upper extremities -The lower extremities may be unaffected or experience a lesser degree of impairment.

Question 7

Anterior cord syndrome:

Answer 7

• usually secondary to anterior spinal artery infarction (spontaneous or secondary to trauma).
• causing anterior 2/3rd of the spinal cord damage
• causes loss of motor function, pain sensation and temperature sensation.
• The posterior 1/3rd of the spinal cord is essentially unaffected; therefore there is no effect to position, vibration and touch sensation.

Question 8

Brown-Sequard syndrome

Answer 8

• occurs typically secondary to a trauma
• one-sided cord damage at all levels below the lesion.
• if damage is through the front (anterior) and back (posterior) of one side of the spinal cord.
• descending tract has ipsilateral (same sided) loss of voluntary motor function.
• The ascending tract has loss of proprioception, and contralateral (opposite injury side) loss of pain and temperature sensation.

Question 9

Conus medullaris syndrome

Answer 9

an incomplete spinal cord injury with damage to the sacral cord, normally due to trauma. This causes a flaccid bowel and bladder, and altered sexual function. The motor function in the legs may be impaired without significant sensory impairment.

Question 10

acute SCI

Answer 10

This occurs when nerves of the spinal cord are damaged, and there is complete loss of motor, sensory, reflex & automatic function below the level of injury. As the spinal cord itself is contained within the more rigid spinal column for protection, this is typically a result of a fracture or dislocation of a vertebrae, resulting in compression, stretching or tearing of the spinal cord.

Question 11

hangmans fracture

Answer 11

Extension injury
Bilateral fractures of C2 pedicles
Anterior dislocation of C2 vertebral body
Highly unstable:
If patient feels need to stabilise their head on their neck, holds head & refuses to let go, or states that they feel their head is going to fall off, be concerned

Question 12

Paraplegia:

Answer 12

impairment or loss of motor &/or sensory function in thoracic, lumbar, or sacral segments of spinal cord

Question 13

Tetraplegia: (quadriplegia)

Answer 13

impairment or loss of motor &/or sensory function with damage to neural structures in cervical spinal cord

Question 14

Autonomic dysreflexia

Answer 14

occurs in patients who had spinal shock (can be up to years ago), but it has subsequently resolved with return on autonomic reflexes. A sensory stimulus occurs below the level of the original injury, leading to a massive sympathetic response that the brain cannot control. The sympathetic response results in extreme vasoconstriction, causing a sudden severe increase in blood pressure, severe headache and visual impairment. The baroreceptors sense the BP and stimulate the vagal nerve to slow the heart and produce compensatory bradycardia. This is a medical emergency, necessitating immediate resolution of the problem. Often, the stimulus is a distended bladder (or bowel), or a pain/discomfort stimulus.