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Clinical Med (Year 2) > Spinal Cord Injury (Exam 2) > Flashcards

Spinal Cord Injury (Exam 2) Flashcards

1
Q

What is a traumatic SCI and what is it caused by?

A
  • Irreversible damage to the spinal cord
  • Caused by: mechanical force
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2
Q

Traumatic SCI: MOI
What factors can affect vertebral injury?

A
  • Direction of force applied to system
  • Position of person’s head at time of injury
  • Magnitude, rate of application and duration of injuring force
  • Point of application
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3
Q

What are the most common damaging forces in the C-spine?

A
  • Flexion
  • Vertical loading
  • extension
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4
Q

In hyper flexion injury anterior structures are (BLANK) and posterior structures are (BLANK)

A
  • Compression anterior
  • Posterior are distracted
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5
Q

What areas of the C-spine are most commonly injured during hyper -flexion injury?

A

C5-C7

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6
Q

What type of cord syndrome can be caused because of a hyper-flexion?

A

anterior cord syndrome

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7
Q

(Cervical) Flexion with rotation mechanism of SCI is often seen with what?

A

Lateral flexion

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8
Q

What does flexion with rotation MOI often result in?

A
  • Dislocation and locking of a single facet joint
  • Possible fracture of lamina or pedicle
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9
Q

What neurological damage can occur in a flexion with rotation MOI?

A
  • Brown Sequard
  • Nerve roots
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10
Q

A vertical compression/axial loading MOI occurs with what type of force?

A

High velocity blow to top of head

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11
Q

Vertical compression/axial loading MOI often have what injury associated with them?

A
  • Often have burst fracture
  • Fracture fragments may migrate posteriorly and enter spinal canal and lodge in cord
  • Rupture of disc
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12
Q

Where does vertical compression/axial loading most often occur in the C-spine?

A

C4-C5 resulting in complete quadriplegia

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13
Q

What force cause can cause a hyperextension injury to the cervical spine?

A

Strong posterior force
- Rear end collision
- Fall & hit chin or forehead

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14
Q

With hyperextension of cervical spine structure anterior are (BLANK) and structures posterior are (BLANK)

A
  • Anterior is distracted
  • Posterior is compressed
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15
Q

What cord lesion can hyperextension cause?

A

Central cord lesion

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16
Q

Why is the thoracic spine more stable than the cervical spine?

A

Rib cage T1-T10

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17
Q

What junction is most commonly injured?

A

T12-L1

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18
Q

Flexion MOI of the thoracic spine result in what injuries?

A
  • Wedge fracture
  • Posterior ligamentous complex may be damaged due to distractive forces (severe)
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19
Q

Vertebral compression MOI of the thoracic spine results in what injuries?

A
  • Burst fractures result in bone fragments into spinal canal
  • Penetrating injury
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20
Q

What force causes a flexion - rotation injury to the lumbar spine?

A

Posterior to anterior force directed at rotated vertebral column

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21
Q

What injuries are typically caused by flexion-rotation injuries to the lumbar spine?

A
  • Typically causes fracture & dislocation
  • Posterior ligamentous complex is ruptured accompanied by vertebral body fractures
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22
Q

Flexion-distraction (Chance Fracture) often results from what?

A

Use of lap belt without shoulder restraint

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23
Q

How does lap belt cause a flexion - distraction (Chance Fracture)?

A
  • Lap belt becomes a pivot point (fulcrum)
  • Flexion distraction force from that point
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24
Q

In a flexion-distraction (Chance Fracture) how are fractures and ligamentous tears oriented?
- Where is the injury?
- What other injuries may occur?

A
  • Oriented: horizontally
  • Injury in thoraco-lumbar junction
  • May have severe internal injuries
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25
Q

In traumatic SCI often secondary microvascular, biochemical, and cellular processes happen what can this result in?

A
  • Apoptosis, Edema, Inflammation
  • Release of glutamate
  • Imbalance of calcium levels
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26
Q

What are the 6 etiologies of non traumatic SCI?

A
  • Vascular damage (hemorrhage, ischemia, AVM)
  • Space occupying lesion (neoplasm, syrinx, abscess)
  • Infection (transverse myelitis)
  • Primary damage (MS, ALS)
  • Compression (degenerative joint disease)
  • Myelomeningocele (most serious form of Spina Bifida)
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27
Q

What is tetraplegia?
What area of the spine is injured to result in tetraplegia?

A
  • Tetraplegia: involvement of all 4 extremities and the trunk
  • C1-C8
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28
Q

What is paraplegia?
What area of the spine is inured to result in paraplegia?

A
  • Paraplegia: Involvement of the legs and part of the trunk
  • T1-S5
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29
Q

For an injury to be classified as incomplete what needs to be spared?

A

Some sparing of sensory and/or motor function

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30
Q

Where is the highest SCI injury frequency at?

A

C5-C7 and T12-L2

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31
Q

T/F: SCI result in a lot of financial impact

A

True

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32
Q

What is the most common spinal cord injury diagnosis?

A

Incomplete tetra

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33
Q

What is the ABC of the initial management of SCI?

A

Airway
Breathing
Circulation

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34
Q

What is the initial management of SCI?

A
  • Management of life threatening injuries
  • Spinal stabilization/immobilization (no A/PROM, backboard, C- collar)
  • Transportation to trauma center
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35
Q

After arriving at the trauma center after SCI what is done?

A
  • Ensure optimal ventilation & circulation
  • Diagnosis of SCI (physical, neurological & imaging)
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36
Q

What are the types of imaging used to diagnosis SCI?

A
  • Radiographs
  • CT
  • Myelography
  • MRI
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37
Q

What radiographs will be used to diagnose SCI?

A
  • C -Spine lateral radiographs (rapid and effective w/ 85% accuracy)
  • Open mouth & AP radiographs (almost 100% accuracy)
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38
Q

What information does a CT give when diagnosing SCI?

A

Valuable information on impingement on neuronal canal as well as bony limits of spinal cord

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39
Q

T/F: Myelography is rarely used alone, may be used in conjunction with CT

A

True

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40
Q

What information does a MRI give when diagnosing SCI?

A
  • Appropriate imaging technique for visualizing the necessary tissue
  • However, in acute SCI other equipment in the surrounding area may limit its use
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41
Q

Once the patent is in the ICU they receive close monitoring of what systems?

A
  • Respiratory Status
    (may require ventilator)
  • Organ function
  • Cardiovascular status
    (avoid hypotension & hypoxia)
  • Bowel/bladder management (catheter insert)
  • Integumentary integrity
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42
Q

T/F: There is not evidence to support the use of pharmacologic agents to improve outcomes

A

True

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43
Q

What is the intent of high dose steroids?

A
  • Reduce edema to increase motor recovery

New research shows does not lead to improved functional outcomes & can have negative effects

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44
Q

What is the purpose of acute pharmacological management of SCI?

A
  • Aimed at managing neurologic sequelae & secondary complication (pain, heartburn/ulcers, infection, constipation, preventive)
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45
Q

What is the intent of local & systemic hypothermia?

A
  • Reduce secondary damage & neuroprotection
  • Body temp is systematically cooled to minimize secondary ischemia. cell death, oxidative stress, inflammation & edema
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46
Q

T/F: Further research is needed on the effectiveness and dosage of local & systemic hypothermia

A

True

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47
Q

When is an open reduction surgery indicated?

A
  • Unstable fracture site
  • Cord compression
  • Malalignment
  • Deteriorating neuro status
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48
Q

When is open reduction surgery recommended to take place?

A

Early: within 24 hours

49
Q

What are some non-surgical intervention options?

A
  • Traction devices (cervical subluxation, fracture/dislocation)
  • Immobilization (potentially positions in a rotating bed)
50
Q

When is immobilization indicated?

A

Whether closed or open reduction

51
Q

When is Halo immobilization indicated?

A
  • Cervical fractures
  • Most effective at decreasing cervical rotation
52
Q

What immobilization tactics are used in acute medical management of SCI?

A
  • Halo
  • Spinal orthosis
  • Recumbent positioning
53
Q

What are some factors to keep in mind when your patient is immobilized?

A
  • Aware of wearing schedules
  • Monitor skin integrity (pads should be changed routinely and be aware of pressure areas)
  • impact on plan of care
54
Q

Traumatic SCI before age 15 is relatively rare, but when it does occur what are some MOI?

A
  • MVA
  • Sport related injuries
  • Falls
  • Abuse
55
Q

In pediatric SCI injury to what level is most common?

A

Cervical level injuries

56
Q

What are some non-traumatic causes of pediatric SCI?

A
  • Myelomeningocele/ Spina Bifida
  • Tumor or Abscess
  • Transverse Myelitis
  • AV Malformation
  • Compressive myelopathies
  • SC infarction due to thromboembolic disorders
  • Developmental abnormalities of the cervical vertebrae
57
Q

What are some back board consideration for stabilization of pediatric SCI?

A
  • Used with infants and toddlers to allow for neutral alignment of c-spine
  • Occiput cut-out
  • Elevating torso pad
58
Q

What does SCIWORA stand for?

A

Spinal Cord injury without Radiographic Abnormality

59
Q

T/F: SCIWORA is common in pediatrics

A

True

60
Q

What is the most common sign of SCIWORA?

A
  • Signs of acute trauma but no findings on CT or X-Ray
  • Midline Cervical tenderness most common sign
61
Q

What are some treatments for Pediatric SCI?

A
  • Similar treatment of anterior decompression & spinal stabilization surgeries
  • Halo for younger children
62
Q

Who has a slightly better prognosis & neurologic recovery following an SCI?

A

Pediatric > Adults
Incomplete > complete

63
Q

After a Pediatric SCI the individual has a high likelihood of developing (BLANK) and what is the treatment?

A

Scoliosis
- 23% to 97% likelihood when SCI occurs before teenage growth spurt (<12y/o)
-Treatment: Bracing or Surgical intervention

64
Q

In pediatrics depending on the SCI location muscle imbalance can cause what?

A
  • Abnormal growth & contractures
65
Q

When SCI occurs at a young age what are some concerns involving bowel & bladder?

A

smaller capacity to hold urine and increased risk of renal disease

66
Q

T/F: An implication of pediatric SCI is osteoporosis with high incidence of fracture

A

True

67
Q

T/F: Multidisciplinary Rehab and Family Centered Care is important throughout life after pediatric SCI

A

True

68
Q

What is transient reflex depression after spinal shock?

A

Abrupt withdrawal of connections between cortex and spinal cord

69
Q

Spinal shock is characterized by what?

A
  • Areflexia (loss of reflexes–> bulbocavernosus, cremasteric, babinski)
  • Impaired autonomic regulation (hypotension, no sweating, no pilo-erection)
70
Q

How long does spinal shock last?

A
  • Total areflexia = 24 hours
  • Gradual return of reflexes in 1-3 days
  • Increasing hyperreflexia up to 4 weeks
71
Q

SCI Classification: Basics
SCI A:
- Injury Type?
- Description?

A

Injury Type: Complete
Description: Absent

72
Q

SCI Classification: Basics
SCI B:
- Injury Type?
- Description?

A

Injury Type: Sensory Incomplete
Description: Absent Motor, Have some sensation

73
Q

SCI Classification: Basics
SCI C:
- Injury Type?
- Description?

A

Injury Type: Motor Incomplete
Description: < 50% mm have ≥ 3/5 below NLI, Have sensation

74
Q

SCI Classification: Basics
SCI D:
- Injury Type?
- Description?

A

Injury Type: Motor Incomplete
Description: ≥ 50% mm have ≥ 3/5 below NLI, have sensation

75
Q

What is an Anterior Cord Syndrome caused by and what is injured?

A
  • Caused By: flexion injury to the cervical spinal cord
  • Damage: Anterior cord damage (fx, dislocation or cervical disc protrusion) & Anterior spinal artery
76
Q

What is lost in an Anterior Cord Syndrome?

A
  • Motor Function (CST)
  • Pain/temp (ALS/ Spinothalamic Tract)
77
Q

What is preserved in an Anterior Cord Syndrome?

A

Light touch, proprioception, vibration (DCML)

78
Q

T/F: With an Anterior Cord Syndrome longer rehabilitation is usually required

A

True

79
Q

What is the most common SCI syndrome?

A

Central Cord Syndrome

80
Q

What is central cord syndrome caused by?

A
  • Hyperextension injury of cervical spine
  • Congenital/degenerative narrowing of spinal canal leading to hemorrhage and edema in central cord
81
Q

What is the clinical presentation of central cord syndrome?

A
  • UE > LE involvement
  • Motor > Sensory Impairments
  • Sacral Tract may be preserved
82
Q

Patients with a Central Cord Syndrome typically recover ability to (BLANK) but severe limitations in (BLANK)

A

Recover ability to ambulate
Severe limitation in ADLs

83
Q

Brown-Sequard Cord Syndrome is caused by what?

A
  • Hemi section of the spinal cord injured
  • Gunshot or stab wound
84
Q

What is the clinical presentation of Brown-Sequard Cord Syndrome?

A
  • Ipsilateral: DCML & CST (loss of proprioception/Vibration/Motor function
  • Contralateral: ALS (Loss of pain & temp) (Potentially several levels lower than the LOI)
85
Q

What is the least common clinical cord syndrome?

A

Posterior Cord Syndrome

86
Q

What does the posterior cord syndrome affect and what is lost?

A

-Affect: Posterior Columns (DCML)
- Loss: Proprioception & vibration below level of injury

87
Q

What is preserved with posterior cord syndrome?

A

Muscle strength, pain & temperature sensation

88
Q

What are some MOI of posterior cord syndrome?

A
  • Neck hyperextension
  • posterior spinal artery occlusion
  • tumors
  • disc compression
89
Q

Describe Conus Medullaris Syndrome

A
  • L1 lesion
  • UMN & LMN signs
90
Q

What is a Cauda Equina injury?

A
  • LMN lesion (incomplete more common)
91
Q

What is the clinical presentation of Cauda Equina Injury?

A
  • Bowel/bladder impacted (areflexic)
  • Saddle anesthesia
  • LE paresis (L2, L3, L4 vs L5, S1, S2 injury)
92
Q

Why is the potential for regeneration after Cauda Equina injuries poor?

A
  • Large distance between lesion & innervation site
  • Axonal regeneration may not occur along original distribution
  • Glial - collagen scarring block regeneration
  • End organ/mm may no longer be functioning
  • Rate of regeneration slows & finally stops after 1 year
93
Q

What is the impact of SCI across the ICF?

A

Impairments

94
Q

What are the primary implication of SCI impairments?

A
  • Motor & Sensory Impairments
  • Autonomic Dysfunction
  • Cardiovascular Impairments
  • Abnormal Tone
  • Pulmonary/Respiratory Impairment
  • Bowel/Bladder/Sexual Dysfunction
  • Pain
95
Q

What are some secondary impairments of SCI?

A
  • Pressure ulcers
  • DVT
  • Contractures
  • Osteoporosis
  • Psychosocial Impact
  • Heterotrophic Ossification
96
Q

What determines the motor & sensory impairments and what are they related to?

A
  • Determined by: International Standards for Neurological Classification of Spinal Cord Injury (ISNSCI)
  • Related to: Level of injury (deficits below), Completeness of injury, clinical syndrome may be present
97
Q

After spinal shock resolves below level of injury what occurs?

A

spastic hypertonia

98
Q

Spastic hypertonia occurs after what? And what does it include?

A
  • After UMN injury (more common in c/s injuries)
  • Includes
    • Spasticity
    • Hyperactive reflexes
    • Clonus
    • High muscle tone
    • mm spasms
99
Q

Spastic hypertonia has a gradual increase up to (BLANK) months and plateau at (BLANK)

A
  • Increase up to 6 months
  • Plateau at 1 year
100
Q

What is spastic hypertonia triggered by?

A
  • UTI
  • Pressure ulcers
  • Stress
  • Temperature
  • Pain
  • Positional changes
  • Tight clothing
101
Q

What are some functional implications of spastic hypertonia?

A

Either can be helpful or hinder

102
Q

In relation to Autonomic Dysfunction- Cardiovascular Impairments: What are the signals to the heart?
- Parasympathetic Output?
- Sympathetic Output?
- C7 Injury implications?
- T10 injury implications?

A
  • Parasympathetic Output: Vagus N
  • Sympathetic Output: T1-L2 (Specific concerns are above T6)
  • C7 Injury implications: Full parasympathetic & no sympathetic
  • T10 injury implications: Both sympathetic & parasympathetic
103
Q

In regards to autonomic dysfunction, what is spinal shock?

A
  • Altered physiologic state immediately after a SCI, which presents as loss of spinal cord function caudal to the level of the injury, with flaccid paralysis, anesthesia, absent bowl & bladder control, and temporary loss of reflex activity
  • Over once bulbcavernousus reflex return (pudendal nerve)
104
Q

In regards to autonomic dysfunction, what is neurogenic shock?

A
  • Refers to the hemodynamic instability seen in these patients with hypotension, bradycardia, and hypothermia (secondary to sympathetic- parasympathetic dysfunction/imbalance).
  • Occurs in injuries above T6 (>50% loss of sympathetic innervation)
105
Q

In regards to autonomic dysfunction (cardiovascular impairments) the impairment neurogenic shock results in (initial weeks in above T6 injury)?

A
  • SBP < 100mmHG
  • HR < 80 bpm
  • Parasympathetic unopposed
106
Q

In regards to autonomic dysfunction (cardiovascular impairments) the impairment bradycardia initially results in?

A

100% in AIS A & B Cervical injury

107
Q

In regards to autonomic dysfunction (cardiovascular impairments) the impairment hypotension, orthostatic too, results in?

A

Dilation of peripheral vasculature below LOI

108
Q

In regards to autonomic dysfunction (cardiovascular impairments) the impairment autonomic dysreflexia is?

A

Life-threatening

109
Q

Orthostatic hypotension is caused by what?

A

Impaired sympathetic output to the heart, unopposed parasympathetic input –> Bradycardia & Peripheral dilation

110
Q

Orthostatic hypotension causes:
- (BLANK) muscle activation
- (BLANK) time in bed
- Beware coming to (BLANK)

A
  • Decrease muscle activation
  • Prolonged time in bed
  • Beware coming to sit or stand
111
Q

What are some symptoms of Orthostatic hypotension?

A
  • Light headed
  • Dizzy
  • Blurred vision
  • Pale
112
Q

Autonomic Dysreflexia occurs with with injures above what level?

A

T6

113
Q

What is the order of events that cause autonomic dysreflexia?

A

Noxious stimuli below lesion –> afferent input to SC –> overactive sympathetic activity (mass reflex response) –> increase BP –> overactive parasympathetic above

114
Q

If autonomic dysreflexia is not addressed quickly what can it result in?

A
  • Seizures
  • Cardiac arrest
  • SAH
  • Stroke
  • Death
115
Q

What are some causes of Autonomic Dysreflexia?

A
  • Bowel bladder distention/irritation
  • Painful stimuli
  • Sexual activity
  • Labor
  • Stretching a patient too far
  • Fracture
  • E swim below the level
116
Q

What are some signs/symptoms of autonomic dysreflexia?

A
  • HTN
  • Bradycardia
  • Severe headache
  • Profuse sweating above the level
  • Increased spasticity
  • Vasodilation above level of injury (flushing-overactive parasympathetic activity)
  • Vasoconstriction below (overactive sympathetic activity)
  • Constricted pupils, blurred vision, nasal congestion, pilo-errection
117
Q

What is the management of autonomic dysreflexia?

A
  • Upright position
  • Remove source of noxious stimulus
  • Monitor vital
  • Seek medical attention if unable to resolve
  • Education
118
Q

Blood pressure following SCI will like be (BLANK) especially with (BLANK) level injuries

A

Blood pressure following SCI will like be lower especially with higher level injuries

119
Q

In patients with tetraplegia:
- Average supine systolic BP?
- Average seated systolic BP?

A
  • Average supine systolic BP: about 110 mmHg
  • Average seated systolic BP: about 100 mmHg

Clinical Med (Year 2) (17 decks)

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