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Neuromuscular management > Lecture 8 - SCI > Flashcards

Lecture 8 - SCI Flashcards

1
Q

Where does the spinothalamic tract cross

What’s it do?

A

Anterior Commisure at same level it enters spinal cord

Pain and temp

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2
Q

Where does the DCML tract cross?

What does it do?

A

In medulla

Proprioception, fine touch

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3
Q

Where does the corticospinal tract cross?

What’s it do?

A

In medulla pyramids

Motor

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4
Q

Where is the sympathetic NS located

Where is the parasympathetic NS located

A

T1 to L3

Brainstem and S2-S4

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5
Q

What is the most common cause of SCI

A

Vehicular accidents

Mainly affects males

Most common outcome: incomplete tetraplegia

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6
Q

How do you manage an emergent case of SCI

A

Immobilization of head and neck

Airway protection

Avoid hypotension

Emergent plain films and CT scan of spine

Surgical decompression (needed within first 24 hours)

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7
Q

Most traumatic injuries occur where in the spine?

A

50% cervical. Most commonly C5 followed by C4.

Thoracic next most common, then lumbar

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8
Q

A lesion around what level will cause quadriplegia vs paraplegia

A

Below cervical (C8) - paraplegia

Above cervical- quadriplegia

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9
Q

What is considered the gold standard of spinal cord injury assessment

A

ASIA international standards for neurological classification of spinal cord injury ISNCSCI

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10
Q

What does someone’s “motor level” and “sensory level” mean in a SCI

A

The lowest level still intact

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11
Q

Muscle groups in ASIA:

C5

C6

C7

A

Elbow flexor

Wrist extensor

Elbow extensor

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12
Q

Muscle groups in ASIA:

C8
T1
L2

A

Finger flexors
Small finger abductors
Hip flexors

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13
Q

Muscle groups in ASIA:
L3
L4
L5
S1

A

Knee extensors
Ankle dorsiflexors
Long toe extensor
Ankle plantarflexors

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14
Q

How is sensory graded in ASIA?

A

0- absent
1 altered/ impaired/ hypersensitive
2 - normal
NT- not testable

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15
Q

What does A mean on the ASIA impairment scale?

A

Complete (cord injury): no sensory or motor preserved in s4 s5

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16
Q

What does B mean in the ASIA scale?

A

Sensory incomplete

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17
Q

What does C mean in the ASIA scale?

A

Motor incomplete (more than half)
<3 on MMT

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18
Q

What does D mean in the ASIA scale?

A

Motor incomplete: less than half (less than half of function is gone)
>3 on MMT

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19
Q

What does E mean on the ASIA scale

A

Normal

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20
Q

What is spinal shock?

A

Immediate flaccidity and loss of sensory and automatic function below the level of a lesion

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21
Q

What does spinal shock present like?

How long does it last

A

Atonic bladder with overflow incontinence

Atonic bowel with gastric dilation

Loss of vasomotor control

Lasts days to several weeks

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22
Q

After spinal shock, what normally happens in a SCI?

A

Increased reflexes and spasticity below the level of the lesion

pathological pyramidal reflexes(Babinski and hoffman)

Spastic bladder

Paralyzed legs w/ flexion contracture

autonomic dysreflexia (depending on level)

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23
Q

SCI above what level causes babinski reflex? Hoffman?

A

Babinski - S1

Hoffman - C7

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24
Q

Autonomic Dysreflexia happens with spinal cord injuries above _____

A

T5

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25
Disabilities associated w/ C1-C5 tetraplegia: at what level do you have independent verbal communication?
* Bathing and dressing: dependent * communication: independent w/ assistive device C1-C3 Independent verbal communication **C4-C5** Assistive device necessary for keyboarding, writing, page turning, use of telephone
26
Disabilities associated w/ level of C6-C8 tetreplegia At which level of injury can they use a **wheelchair**? How is **dressing**?
* Dressing: independent with AD in bed (C7) or **wheelchair C8** * Minimal assistance dressing * moderate assistance undressing * those w/ C8 injury can dress and undress in wheelchair
27
Disabilities associated w/ level of C6-C8 tetreplegia How is Bathing? Upper body? Lower body?
* Minimal assistance for upper body bathing and drying * Moderate assistance for lower body drying * C7 and C8 are independent w/ use of assistive devices * AD include tub chair
28
Disabilities associated w/ level of C6-C8 tetreplegia How is **communication**?
* Independent verbal communication * AD necessary for keyboarding, writing, use of phone * **C6** may require set up
29
Disabilities associated w/ T1 injury How is Dressing, bathing and communication
Dressing: independent w/ assistive device Bathing - Independent w/ use of assistive device communication - independent (arms are fine)
30
What are symptoms of autonomic dysreflexia
**Hypertension** (up to 300mmHg systolic) **sweating** (above the injury) **Flushing** (above the injury) **Bradycardia** (vagus nerve is still working note: usually due to complete transverse cord lesion, risk increases after recovery from spinal shock when transfering to rehab
31
Autonomic dysreflexia triggers:
Full Bladder Full or impacted bowel Scrotal compession kidney stones gastritis onset of menses DVT Pulmonary Embolism Pressure ulcers change in temp pain or irritation below level of lesion basically they cannot feel these things to address them
32
Autonomic dysreflexia is a sudden increase in BP by _____________ resulting from harmful, painful, or injurous stimulus **below** the level of a spinal cord lesion How should you position a patient whos having autonomic dysreflexia?
20-40mmHG Sit patient **upright** (90 degrees) Monitor BP every 2-3 minutes
33
What are cardiovascular complications of a SCI?
Arrhythmias, fluctuating BP, orthostatic hypotension thrombophlebitis, pulmonary embolisms, edema (this is why these patients need compression, exercise, and early mobility)
34
What are respiratory complications of a SCI?
impaired cough and reduced ability to mobilized secretions (making them more suseptible to pneumonia) increased risk of obstructive sleep apnea reduced exercise tolerance
35
What are nutritional complications of a SCI?
**high catabolic state** prone to **poor wound healing** and infection associated **paralytic ileus** which may prevent oral feeding **gastritis and stress ulcers** (prevented with medications)
36
What are skin complications w/ SCI?
Ulcers, Osteomyelitis, Sepsis Bony Prominences Prevent with scheduled position changes
37
What are sexual complications of a SCI
Men: impaired libido, potency, fertility women: impaired libido and sexual response, fertility is maintaned
38
What are the leading causes of death for SCI patients
sepsis pneumonia respiratoy failure highest death rate is in first year
39
Cervical spondylosis is most common at what disc levels?
C5 C6 due to bulging discs, bone spurs. thickening of ligaments, compromise of cord and roots
40
If nerve roots are involved we might treat w/ ______ but if theres spinal cord involvement then you ________
Physical therapy Need a surgery
41
What are cervical spondylotic myelopathy symptoms
Pain Burning Weakness Numbness Tingling Bowel and bladder Lhermitte phenomenon
42
How does spondylotic myelopathy progress?
**Gait impairment** often happens early **Lower limb** will have **sensory** problems if dorsal column is compressed lateral arm weakness and loss of finger dexterity cervical radicular dysfunction
43
Where is an intramedullary spinal cord tumor?
Within the spinal cord
44
where is an extramedullar-intradural spinal cord tumor?
lying on the surface of the cord arising from roots or meninges
45
where is an extradural spinal cord tumor located?
in the extra dural space but can compress spinal cord
46
Where at the majority of spinal cord metastases located?
70% thoracic 20% lumbar 10% cervical
47
What cancers most often spread to the spinal cord?
Lung, breast, prostate, kidney, thyroid, gut symptoms: back pain, tenderness, paraparesis, incontinence
48
49
What are the symptoms of an epidural abscess? How is it diagnosed and treated?
Fever, local pain, radicular pain, rapid progressive paraparesis and sensory loss **diagnosis**: emergency MRI **Treatment**: laminectomy, **drainage**, antibiotics
50
What can cause Posterolateral column syndrome?
B12 deficiency Copper deficiency cervical spondylosis paraneoplastic myelitis HTLV1 myelopathy
51
What is subacute combined degeneration? What vitamins are deficient? What tracts does it involve?
**Spinal cord syndrome** resulting from deficiency of vitamin **B12** or **copper** involved **posterior columns and corticospinal** tracts
52
What are the symptoms of subacute combined degeneration
**DCML** and **corticospinal** tracts r involved resulting in weakness paresthesias sensory ataxia gait unsteadiness
53
What causes B12 deficiency? where is B12 found?
**Impaired absorption** d/t gastric bypass, anemia, or IBS found in **meat, eggs, milk**, fortified foods
54
What can cause posterior column syndrome?
Neurosyphilis (tabes dorsalis) early cervical spondylotic myelopathy radiation induced myelopathy
55
What is syphilis(Tabes dorsalis)? How does it present?
**Sexually transmitted infection** causes **dorsal column demyelination** in chronic untreated infections -rare today -impaired sensory and gait imbalance/ataxia -absent reflexes with normal strenght
56
What causes hemicord syndrome?
Gunshot/knife MS Epidural abscess
57
Hemicord syndrome affects the ________ corticospinal tracts __________ DCML tracts _____________ spinothalamic tracts
Ipsilateral corticospinal - UMN weakness below lesion Ipsilateral DCML - loss of sensory and proprioception below level of lesion Contralateral spinothalamic- loss of pain and temp 1-2 levels below the lesion
58
Hemicord syndrome affects the _______ anterior horn the _______ nerve root and the ________ descending autonomic fibers
ipsilateral anterior horn - ipsilateral lower motor neuron weakness ipsilateral nerve root- ipsilateral nerve pain ipsilateral autonomic fibers- impaired sweating
59
What can cause central cord syndrome?
Syringomyelia intramedullary tumors neuromyelitis optica (**NMO**) cervical hyperextension
60
What is central cord syndrome?
Swelling in middle of spinal cord, often from cervical myelitis
61
What is syringomyelia?
Central cavitation in spinal cord most commonly in cervical region -idiopathic -associated w/ tumor or hemorrhage -associated w/ brain malformatin -late complication of spinal cord trauma
62
How does syringomyelia present?
segmental weakness and atrophy of hands and arms w/ **loss of tendon reflexes** **"cape distribution"** may need surgical **drainage** of cyst
63
What is a common cause of anterior cord syndrome?
anterior spinal artery stroke
64
What is usually preserved in anterior spinal cord syndrome? what is normally affected?
Pain and temp preserved, DCML preserved mainly motor loss
65
What are the symptoms of conus medullaris/ cauda equina syndromes? ______ _______ UE strength and sensation ______ reflexes in legs sensory loss in ___________ ___________ leg weakness impaired ________________ function
**Pain** unilateral/bilateral radicular **preserved** UE strength and sensation **absent** reflexes in legs sensory loss in **proximal legs**/ **saddle anesthesia** **proximal lower** leg weakness impaired **B&B** function
66
What can cause conus medullaris/cauda equina syndromes?
Disc herniation Vascular infections radiation neoplastic disorders inflammatory disorders

Neuromuscular management (19 decks)

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