lecture 5 GD: spianl cord disease Flashcards
(84 cards)
1
Q
when do the spinal cord end
A
between L1 and L 2
2
Q
where is the cauda equina
A
S1-S5
3
Q
what sacral vertebrae are fused to make up the ___
A
sacrum
4
Q
the cocygeal vertebrae are fused to make the ___ c
A
coccyx
5
Q
sensation of ___ spinal nerves root is level with he pubic bone
A
T12
6
Q
what spinal nerve root is level with the abdomen
A
t10
7
Q
what spinal nerve root is level with the bottom of the sternum
A
t6
8
Q
the intermediolateral column is from which vertebrae levels
A
c8-t3
9
Q
the anterior horn is ___ and the posteiror horn is ____
A
motor
sensory
10
Q
what does the spinothalamic tract do
A
pain and temperature
11
Q
what does the dorsal column tracts do
A
proprioception/ vibration / gross touch
12
Q
what does the cortiospinal tract do
A
motor
13
Q
where does the dorsal column tract cross
A
internal accurate fibers in medulla
14
Q
where does the spinothalamc tract cross
A
anterior commissure
15
Q
where does the cortiospinal tract cross
A
pyramidal decussation
16
Q
where is the parasympathetic in the spinal cord and where is the sympathetic
A
para - sacral cord
sym- thoracic
17
Q
what are clues to a spinal cord lesion by the history/exam
A
-bilateral symptoms
-bladder.bowel/sexual dysfunction
- stiffness in legs
-neck or back pain w flexion/extension
-lherimitte or uhthoff phenomenon
-sensory level
-tight band sensation across trunk or torso
18
Q
what type of impairments will u get w brownsequard syndrome
A
contralateral sensory and ipsilateral motor
19
Q
what impairments will central cord syndrome present with
A
imparied motor function of UE and sensory impairments for LE
20
Q
what are the 2 most common complete transverse lesion causes
A
spinal cord trauma and tumor w cord compression
21
Q
MOI for complete transverse lesion
A
hyperflexion or hyper extension
22
Q
what is the primary injury for SCI
A
-compression
-laceration
-shearing
23
Q
• Vasogenic edema
• Microvessel
vasospasm
• Thrombosis
• Ion imbalance
• Loss of sodium
gradient
• Inflammation
• Glutamate
excitoxicity
• Free radicals
when does these things happen for SCI
A
minutes to hours after
24
Q
what level of injury is the most
A
cervical injury level
25
what does quadriplegia mean
loss of movement and sensation in all four limbs
26
what is paraplegia
loss of movement and sensation in the lower half of the body
27
what is used as an spinal cord assessment
ASIA .. international scale done in supine
28
what does the ASIA scale tell us
what section is reserved and what is impacted
29
what are the key mm groups in ASiA
C5 Elbow flexors
C6 Wrist extensors
C7 Elbow extensors
C8 finger flexors
T1 Small finger abductors
L2 Hip flexors
L3 Knee extensors
L4 Ankle dorsiflexors
L5 Long toe extensor
S1 Ankle plantar flexors
30
what mm function grading is it if the patient has active movement , full ROM against gravity and moderate resistance in a mm specific position
4
31
what mm function grading is it if the patient has active movement , full ROM against gravity
3
32
what mm function grading is it if the patient has active movement , full ROM against gravity and sufficient resistance to be considered normal if identified factors were not present
5*
33
what mm function grading is it if the patient has active movement full ROM with gravity eliminated
2
34
what impairment letter scale would it be if no sensory or motor function is preserved in the sacral segments S4-5
A. complete
35
what impairment letter scale would it be on the ASIA scale if they have sensory but not motor function is preserved bellow the neurological level and includes the sacral segments S4-5 and no motor function is preserved more than three levels below the motor level on either side of the body
B. sensory incomplete
36
what impairment letter scale would it be on the ASIA scale if motor function is preserved below the neurological level and more then half of key mm functions below the neurological level of injury have a mm grade less than 3
C motor incomplete
37
what impairment letter scale would it be on the ASIA scale if motor function is preserved below the neurological level and at lease half of key mm function is below the neurological level of injury have a mm grade >3
D. motor incomplete
38
what impairment letter scale would it be on the ASIA scale is sensation and motor function as tested with the ISNCSCI are grades as normla in all segments and teh pateint had prior deficits
E. normal
39
what are the steps of classification for a SCI
1. determine sensory levels for right and left sides
2. detmermine motor levels for right and left left sides
3. determine the neurological level or injury
4. determine weather the injury is compete or incomplete
5.detemine ASIA impatient scale
40
if there are at least half or more of the key mm below the neurological level of injury graded as 3 to better ? if yes ? if no?
no is ASIA c
yes is ASIA D
41
what is Immediate flaccidity and loss of sensory and autonomic
function below the level of the lesion.
spinal shock
42
spinal shock is replaced by increased ___, ___ below the level of lesion
reflexes , spasticity
43
___ ____ with lesions above T5 level
autonomic dysreflexia
44
what are disabilities associated with level of injury C1-C5 tetraplegia
-dressing
-bathing
-communication
45
how can a T1 and below paraplegia dress, bath and communicate
independent with use of assistive device for dress and bath and independent with commnicatoin
46
what is. Exaggerated sympathetic response to noxious stimuli below lesion
Autonomic Dysreflexia
47
what are symptoms of Autonomic Dysreflexia
– Hypertension ( to 300 mmHg systolic)
– Sweating (above injury)
– Flushing (above injury)
– Bradycardia (vagus still working)
48
Autonomic Dysreflexia is associated with level above ___
T5
49
Autonomic Dysreflexia has an increased risk after recovery from what
spinal shock
50
* Full bladder
* Full or impacted bowel
* Scrotal compression
* Kidney stones
* Gastritis
* Onset of menses
* Deep venous thrombosis
* Pulmonary embolus
* Pressure ulcers
* Changes in temperature
* Pain or irritation below the level of the lesion
these are all triggers for what
autonomic dysreflexia
51
what are cardiovascular complications with SCI
• Arrhythmias, fluctuating blood pressure, orthostatic hypotension
- thrombophlebitis and PE
-edema
52
what are respiraotry complications in SCI
-• Impaired cough and reduced ability to mobilize secretions
– Increased risk of pneumonia • Increased risk of
obstructive sleep apnea
• Reduced exercise tolerance
53
what rehab do u do fo SCI
-ROM
-stretching
-orthotic devices
54
what are the leading causes of death for SCI
-sepsis
-pneumonia
-respiraotry failure
55
what is cervical spondylosis
degenerative disease of the spine with myelopathy and radiculopathy
56
where’s cervical spondylosis most common at
C5-C6
57
what are cervical spondylosis myelopathy symptoms
• Pain
• Burning
• Weakness
• Numbness
• Tingling
• Bowel and bladder dysfunction
• Lhermitte’s phenomenon
58
what is the progression of cervical spondyotic myelopathy
- gait impairment often early
-lower limb sensory symptoms if dorsal column compressed
- lateral arm weakness and loss of finger dexterity
- concurrent cervical radicular dysfunction
59
what kind of SC tumor is within the SC
intramedullary
60
what SC tumor is lying on the surface of the cord , arising from roots or meninges
extrameduallry intradural
61
what SC tumor is in the epidural space but able to compress upon the spinal cord
extra dural
62
what are the primary tumor sites from SC metastases
lung
breast
prostate
kidney
thyroid
gut
63
what are symptoms that present when tumors metastasize to the SC
Back pain, tenderness, paraparesis, incontinence
64
how do u treat tumors that metastasize to SC
high dose of steroids and radiation
65
what may occur with osteomyelitis or skin infection
epidural abscess
66
what are red flag symptoms with epidural abscess
fever, back pain and diabetes
67
what is the treatment with epidural abscess
Laminectomy & drainage, then antibiotics
68
* B12 deficiency
* Copper deficiency
* Cervical spondylosis
* Paraneoplastic myelitis
* HTLV1 myelopathy
these 5 things can cause what syndrome
posterolaterla column syndrome
69
what Spinal cord syndrome resulting from deficiency of vitamin B12 or copper
Subacute Combined Degeneration
70
Subacute Combined Degeneration involves what tracts
posterior columns and corticospinal tracts.
71
what is B 12 found in
eggs, meat , milk and fortified foods
72
• Neurosyphilis (Tabes dorsalis)
• Early cervical spondylotic myelopathy
• Radiation induced myelopathy
these all come with what syndrome
postioer column syndrome
73
tabes dorsalis (syphilis) is a ___ transmitted infection
sexually
74
tabes dorsalis (syphilis) causes ___ ___ demyelination in chronic untreated infections
dorsal column
75
what does tabes dorsalis impair
vibration and proprioception
76
what are symptoms of hemicord syndrome ipsilaterally and contralterally
ipsilateral UMN weaklesnn below the level of lesion
- ipsilateral LMN weaknes at the level of injury (anterior horn)
-ispi loss of vibration and proprioception (posteior column uncrossed)
- ispi nerves root pain
-ispi imparted sweating (descending autonomic fibers)
-contra loss of pan and temp 1-2 levels below the lesion (spinothalamic tract crossed(
77
* Syringomyelia
* Intramedullary Tumors
* Neuromyelitis Optica
* Cervical Hyperextension
these can all be from what syndrome
central cord syndrome
78
what is Central cavitation (syrinx) of the spinal cord
Syringomyelia
79
where is Syringomyelia most commonly in
cervical region
80
Syringomyelia has segmental weakness and atrophy of ___ and ___ with loss of tendon reflexes
hands and arms
81
what will be lost and whqt will be preserved with anterior cord syndrome
loss of motor function and preserved position , vibration , and touch sense
82
what is preserved in Conus Medullaris and Cauda Equina Syndromes
UE strength/ sensation
83
what is impaired , where is there sensory loss and where is there weakness for Conus Medullaris and Cauda Equina Syndromes
impaired bowel and bladder funciotn , proximal leg weakness anf sensory loss in proximal legs/saddle anesthesia
84
what are casues of Conus Medullaris and Cauda Equina Syndromes
• Disc herniation
• Vascular
• Infections
• Radiation
• Neoplastic disorders
• Inflammatory disorders
