Week 4- SCI Syndromes and Clinical Presentation Flashcards
PART 1: SCI SYNDROMES
PART 1: SCI SYNDROMES
List the SCI Syndromes. (6)
- Anterior Cord Syndrome
- Central Cord Syndrome
- Brown-Sequard Syndrome
- Posterior Cord Syndrome
- Conus Medullaris Syndrome
- Cauda Equina Syndrome
What constitutes a SCI Syndrome?
When the cord is damaged in a way other than the typical manner thought of with SCI (entire level of cord impacted and impairments seen from there down).
Anterior Cord Syndrome:
- ___% of traumatic SCIs.
- Involves damage to the ______, ________ _______ Artery, or both.
- What is a common MOI?
- Loss of ______ function and _____/______ below level of injury bilaterally.
- ____________ pathways intact.
- 3%
- cord itself, Anterior Spinal Artery, or both
- Flexion injury/ burst fracture causing fragments to compromise Anterior Spinal Artery thus impacting blood supply to anterior 2/3rds of spinal cord.
- Loss of motor function and pain/temp
- Dorsal Column Medial Lemniscus
Central Cord Syndrome:
- ___% of traumatic SCIs.
- Involves damage to central aspect of spinal cord (almost exclusively a ________ injury).
- Common in elderly, or with prior _________ or _______. (typically due to __________ injury and often results from relatively minor trauma)
- Can also occur in younger population with _________ + _________ trauma/herniated disc.
- Are the UEs or LEs affected more?
- Are distal or proximal muscles affected more?
- Sparing of sacral sensation and may have sparing of sacral motor.
- 9%
- cervical injury
- spondylosis or stenosis (extension injury)
- flexion + compression
- UE > LE
- distal > proximal
- What does a Central Cord Syndrome look like?
- Will we ever have a ASIA A Central Cord Syndrome? Why or why not?
- Upside down SCI
- No, because we have sparing of our sacral sensation.
Brown-Sequard Syndrome:
- __-__% of traumatic SCIs.
- Involves damage to ________ of cord (hemi-section or incomplete injury).
- What are some causes?
- Results in ___________ motor/dorsal column symptoms and ____________ anterolateral pathway symptoms. (Ipsilateral _________ common below level of lesion)
- 1-4%
- one side of cord
- knife wound, GSW
- IPSILATERAL, CONTRALATERAL (spasticity)
Posterior Cord Syndrome:
- ___% of traumatic SCIs.
- Results from __________ by disc or tumor, ____ infarct, or __________ deficiency.
- ____________ lost bilaterally below level of lesion.
- ______ and ______/______ preserved.
- How do these patients respond to therapy?
- <1% (extremely rare)
- compression by disc or tumor, PSA infarct, or vitamin B12 deficiency
- Dorsal column
- Motor and pain/temp
- Typically respond well to rehabilitation
Anterior Cord Syndrome Prognosis:
- Prognosis is extremely poor for what (3) things?
- ___-___% chance of motor recovery (even with those with recovery, demonstrate poor power and coordination).
- Bowel and bladder function
- Hand function
- Ambulation
-10-20%
Central Cord Syndrome Prognosis:
- Most people will regain some level of ___________ function. (less so with older patients)
- > ___% will recover bowel and bladder control.
- ______________ last to return (<50%).
- What are positive prognostic factors for Central Cord Syndrome?
- ambulatory function
- > 50%
- Intrinsic hand function
- Good hand function, evidence of early motor recovery, young age, absence of spasticity, pre-injury employment, absence of LE neurologic motor impairment at rehab admission.
Brown-Sequard Syndrome Prognosis:
- Prognosis generally very good.
- Nearly all patients will attain some level of _________ function.
- ___% regain hand function.
- ___% regain bladder control, ___% bowel control.
- ambulatory
- 80%
- 100%, 80%
Conus Medullaris Syndrome:
-Damage to _________ and ________.
-What are some common causes?
-Sudden onset of ______ and _____ symptoms.
-Symmetrical ________ _________.
-Symmetrical ________/__________.
-Can see _____tonicity.
-Distal LE (ankle) ____flexia (may see intact sacral)
-_______ dysfunction.
-____ LBP with potential ____ radicular symptoms.
-B&B dysfunction: typically urinary _______ and
atonic anal sphincter.
- sacral cord and lumbar nerve roots
- Trauma, tumors, infections, stenosis
- LMN and UMN symptoms
- saddle anesthesia (more localized perianal)
- weakness/flaccidity
- hypertonicity
- distal LE areflexia (may see intact sacral reflexes)
- sexual dysfunction
- Mild LBP with potential Mild radicular symptoms
- urinary retention
What does treatment of Conus Medullaris Syndrome include?
-Surgical decompression
What is the cardinal sign of Conus Medullaris Syndrome?
- Symmetrical saddle anesthesia
- Symmetrical weakness/flaccidity
Cauda Equina Syndrome:
-Injury below L1 to lumbosacral roots of peripheral nerves = _____ injury (_____ spared).
-What are some common causes? Acute or chronic?
-Damage to nerve roots is highly variable, incomplete lesions common.
-Symptoms (Gradual onset or Acute)
-Common triad: __________ saddle anesthesia,
______ and/or ______ dysfunction, _________ LE
weakness.
-Variable _______ loss (partial vs complete)
-Flaccid paralysis, areflexia (loss of sacral reflexes)
-Flaccid paralysis of bowel and bladder.
-________ LBP, often with _______ radicular pain.
- LMN injury (cord spared)
- Lumbar burst fx, herniated disc (acute or chronic)
- Asymmetrical saddle anesthesia, bowel and/or bladder dysfunction, asymmetrical LE weakness
- variable sensory loss
- Severe LBP, with severe radicular pain
What does treatment of Cauda Equina Syndrome include?
-Surgical decompression
Cauda Equina Syndrome Prognosis:
- PNS injury = potential for nerve ___________ (however it is often incomplete and tends to plateau after _______)
- Bladder outcomes _______ the longer the cauda equina is compressed.
- Prognosis improves when surgery occurs within _______ of initial presentation.
- Due to potential for regeneration, more favorable prognosis for functional recovery compared to UMN SCI Syndromes.
- nerve regeneration (1 year)
- worsen
- 48 hours
Conus Medullaris Syndrome Prognosis:
- Similar prognostic indicators, but since _____ involvement, prognosis is less favorable than CES.
- ___% regain function.
- UMN involvement
- 10%
PART 2: SCI CLINICAL PRESENTATIONS
PART 2: SCI CLINICAL PRESENTATIONS
High Cervical Injuries (C1-C4) Key Muscles:
- ______ and ______ muscles, ____ innervation.
- Partial innervation of _________ if injury.
- Face and neck muscles, CN innervation
- diaphragm
High Cervical Injuries (C1-C4) Available Movements:
-______, __________, sipping, blowing, ________ elevation.
-Talking, mastication, sipping, blowing, scapular elevation
High Cervical Injuries (C1-C4) Functional Capabilities:
- ADLs: ________; Independent to direct care.
- Dependent bed mobility and transfers; Independent to direct care. Mod I with pressure relief in chair, dependent in bed but can direct care.
- Wheelchair mobility: Mod I with PWC using ______ controls.
- Dependent
- mouth controls
High Cervical Injuries (C1-C4) Required Equipment:
- _____ with appropriate driving control adaptations.
- Portable ventilator. (C1-C2/3)
- Hospital bed with air mattress.
- Hoyer lift.
- Bathroom DME (TIS if shower)
-PWC
High Cervical Injuries (C1-C4):
- __, __, __ will be _________ dependent. This removes the ability to ________ meaning they will need adaptive equipment for communication.
- ___ should be able to eventually wean off vent. They will have a weak cough and often will need cough-assist. They may be able to use ______________ breathing to assist with cough as well.
-These patients require around the clock care and will require 1-2 caregivers. Dependent for driving.
- C1, C2, C3 will be ventilatory dependent, vocalize
- C4, glossopharyngeal
Cervical Injuries (C5) Key Muscles: -Biceps, brachialis, brachioradialis, \_\_\_\_\_\_\_\_\_\_\_, \_\_\_\_\_\_\_\_, \_\_\_\_\_\_\_\_\_, \_\_\_\_\_\_\_.
-Biceps, brachialis, brachioradialis, deltoid, infraspinatus, rhomboids, supinator
