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Caroline Summer 25 2.0 > Lecture 8 - SCI > Flashcards

Lecture 8 - SCI Flashcards

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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

clues to a SC lesion

A

bilateral > unilateral

B&B / sexual dsyfxn

stiffness in legs (inc tone)

neck or back pain - especially if decerebrated by flex/ext

lhermitte or uhtoff

sensory level

tight band sensation across trunk or torso (MS hug)

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3
Q

If you’re having B LE weakness and suspect SC issues but the lumbar/sacral MRI comes back clean - what might be the cause?

A

could be a cervical SC level being compressed bc sacral and lumbar are on outside of cortico tract!

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4
Q

Where does the DCML tract cross?

What does it do?

A

In medulla

Proprioception, fine touch

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5
Q

Where does the corticospinal tract cross?

What’s it do?

A

In medulla pyramids

Motor

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6
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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7
Q

signs of sympathetic involvement

A

tachycardia
BP changes
B&B changes

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8
Q

What is the most common cause of SCI

A

Vehicular accidents then falls

Mainly affects males

Most common outcome: incomplete tetraplegia

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9
Q

< __ % experience complete recovery by hospital discharge

A

1

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10
Q

causes of complete cord syndrome

A

sc trauma

tumor with cord compression

hemorrhage

nectrotizing or demyleinating myelopathy

epidural abscess

vertebral body fracture

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11
Q

step off

A

shows vertebral body damage that looks like a step and can compress SC

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12
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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13
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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14
Q

A lesion around what level will cause quadriplegia vs paraplegia

A

Below cervical (C8) - paraplegia

Above cervical- quadriplegia

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15
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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16
Q

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

A

The lowest level still intact

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17
Q

Muscle groups in ASIA:

C5

C6

C7

A

Elbow flexor

Wrist extensor

Elbow extensor

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18
Q

Muscle groups in ASIA:

C8
T1
L2

A

Finger flexors
Small finger abductors
Hip flexors

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19
Q

Muscle groups in ASIA:
L3
L4
L5
S1

A

Knee extensors
Ankle dorsiflexors
Long toe extensor
Ankle plantarflexors

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20
Q

How is sensory graded in ASIA?

A

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

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21
Q

What does A mean on the ASIA impairment scale?

A

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

(sacral sparing - if these segments are spared its considered incomplete!)

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22
Q

What does B mean in the ASIA scale?

A

Sensory incomplete

have sensation below the level but does not have motor

(sacral spared??)

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23
Q

What does C mean in the ASIA scale?

A

Motor incomplete

motor function is preserved below the level, and more than half of key muscle fxns below the level have MMT < 3

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24
Q

What does D mean in the ASIA scale?

A

Motor incomplete:
motor fxn is preserved below the level and at least half of key muscle functions below the level have MMT > 3

must have sacral sparing for C or D!

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25
What does E mean on the ASIA scale
Normal
26
idk if we need to know this but when determining between B and C the ____ level is used whereas between C and D the _____ is used
motor level neurological level of injury
27
if voluntary anal contraction = no and all S4-S5 sensory score = 0 and deep anal pressure = no the injury is...
complete otherwise, injury is incomplete (sacral sparing)
28
know steps in classification?
29
What is spinal shock?
Immediate **flaccidity** and loss of sensory and automatic function below the level of a lesion
30
What does spinal shock present like? How long does it last
Atonic bladder with overflow incontinence Atonic bowel with gastric dilation Loss of vasomotor control Lasts days to several weeks
31
After spinal shock, what normally happens in a SCI?
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)**
32
SCI above what level causes babinski reflex? Hoffman?
Babinski - S1 Hoffman - C7
33
Autonomic Dysreflexia happens with spinal cord injuries above _____
T5
34
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 will likely be on a vent - diaphragm C3 C4 C5!
35
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
36
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
37
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
38
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)
39
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
40
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
41
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
42
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)
43
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
44
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)
45
what meds should you use to prevent gastritis and stress ulcers
antacids or H2-receptor blockers
46
What are skin complications w/ SCI?
Ulcers, Osteomyelitis, Sepsis Bony Prominences Prevent with scheduled position changes
47
What are sexual complications of a SCI
Men: impaired libido, potency, fertility women: impaired libido and sexual response, **fertility is maintained**
48
What are the leading causes of death for SCI patients
sepsis pneumonia respiratoy failure highest death rate is in first year
49
__ % of pts employed 1 year after the injury
12
50
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
51
If nerve roots are involved we might treat w/ ______ but if theres spinal cord involvement then you ________
Physical therapy Need a surgery
52
What are cervical spondylotic myelopathy symptoms
Pain Burning Weakness - with fine motor skills Numbness Tingling Bowel and bladder Lhermitte phenomenon
53
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 can be concurrent
54
Where is an intramedullary spinal cord tumor?
Within the spinal cord
55
where is an extramedullar-intradural spinal cord tumor?
lying on the surface of the cord arising from roots or meninges
56
where is an extradural spinal cord tumor located?
in the extra dural space but can compress spinal cord
57
Where at the majority of spinal cord metastases located?
70% thoracic 20% lumbar 10% cervical
58
What cancers most often spread to the spinal cord? Symptoms?
**Lung, breast, prostate**, kidney, thyroid, gut symptoms: back pain, tenderness, paraparesis, incontinence
59
what causes an epidural abscess?
may occur with osteomyelitis (infection of the bone) of skin infection, pus spreads to the SC
60
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
61
red flags for epidural abscess
fever, back pain, diabetes
62
What can cause Posterolateral column syndrome?
B12 deficiency Copper deficiency cervical spondylosis paraneoplastic myelitis HTLV1 myelopathy
63
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
64
What are the symptoms of subacute combined degeneration
**DCML** and **corticospinal** tracts r involved resulting in weakness paresthesias sensory ataxia gait unsteadiness
65
What causes B12 deficiency? where is B12 found?
**Impaired absorption** d/t gastric bypass, anemia, or IBD found in **meat, eggs, milk**, fortified foods
66
What can cause posterior column syndrome?
Neurosyphilis (tabes dorsalis) early cervical spondylotic myelopathy radiation induced myelopathy
67
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 strength**
68
What causes hemicord syndrome?
penetrating trauma - Gunshot/knife MS lesions Epidural abscess
69
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
70
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
71
What can cause central cord syndrome?
Syringomyelia intramedullary tumors neuromyelitis optica (**NMO**) cervical hyperextension
72
with central cord syndrome, what region of the body is impacted first? what tract?
cervical (innermost) spinothalamic bc it crosses right in the middle
73
What is central cord syndrome?
Swelling in middle of spinal cord, often from cervical myelitis
74
What is syringomyelia?
Central cavitation in spinal cord (enlarged central cavity, fluid filled cavity) most commonly in cervical region -idiopathic -associated w/ tumor or hemorrhage -associated w/ brain malformatin -late complication of spinal cord trauma
75
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
76
What is a common cause of anterior cord syndrome?
anterior spinal artery stroke
77
What is usually preserved in anterior spinal cord syndrome? what is normally affected?
B pain and temp and motor loss, with DCML spared
78
with conus medullaris/cauda equina, you're seeing SC symptoms however
its really LMN affected bc its at the root level
79
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
80
What can cause conus medullaris/cauda equina syndromes?
Disc herniation Vascular infections radiation neoplastic disorders inflammatory disorders

Caroline Summer 25 2.0 (32 decks)

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