Lecture 9: Concussion and Spinal Cord Disorders Flashcards
Concussion definition
disturbance in brain fxn caused by direct or indirect force to the head
Concussion presentation
fxnl rather than structural injury that can affect somatic, cognitive and affective domains; sleep disturbances also common
Concussion Sx’s
- Headache is most common
- others = dizziness, balance disturbances, disorientation, LOC, suppressed reflexes, fall in BP, transient arrest in reap, convulsive activity, retrograde amnesia
Dx of concussion
- must have temporal rltnshp btwn an appropriate mechanism of injury and onset or worsening of sx
Mechanism of Concussion
- rotational and angular forces to the brain
- shear forces disrupt neural membranes allowing K+ efflux into extracellular space
- have further influx of Ca and AAs which suppress neuron activity
- asa Na/K pumps restore balance, more E needed there so decrease cerebral blood flow
Initial Eval of Concussions
- begin at cervical spine/site of injury
- monitor for deterioration of sx’s over several hours
Hospital Eval/Imaging of Concussions : indications
- pts with LOC or amnesia + one of following: HA, vomiting, age > 60, intoxication, deficits in short term memory, evidence of trauma above clavicle, seizures, GCS < 15, neuro deficits, coagulopathu
- pts with NO LOC or amnesia + one of following: focal neuro deficit, vomiting, HA, age > 65, signs of basilar skull fx, GCS < 15, coagulopathy
Type of imaging
CT = initial choice
MRI
Management
- cognitive rest
- physical rest
- meds/intervention
Spinal cord injury: pathophysiology
- most result from some combo of flexion, flexion-rotation, extension or vertical compression injury to neck or back
- can occur from blunt trauma, perforating wounds, vertebral dislocation or fragments of vert. fx’s
- secondary hemorrhage/edema can lead to spinal cord ischemia
Clinical presentation
- urinary retention/constipation/ilues
- hypotension, bradycardia
- hemiplegia, hemiparesis (sparing face)
- paraplegia, paraparesis
- quadriplegia, quadriparesis
- loss of sensation –> unilateral or bilateral
Imaging for spinal cord injuries
- AP and lateral plain Xray of cervical, thoracic and lumbar spine
- CT: preferred for defining vert. injuries, can show evidence of edema or hemorrhage
Complete transection of spinal cord
- disrupts all ascending and descending neural pathways within cord
- causes total loss of all motor fxns and sensation below injury
- 99% with this injury will have NO recovery
High cervical complete transection
-quadriplegia, anesthesia in trunk and all extremities, and resp. failure
Thoracic or Lumbar injuries
-paraplegia, loss of sensation in LE
Determination of level of complete transection injury
-determine dermatomal level which sensation is lost
Incomplete spinal cord lesion
- usually due to edema or hemorrhage within cord causing sensory/motor interruption
- regain fxn over weeks to mnths
- will have intact sensation in perianal, anal sphincter tone or slight flexor toe mvmnt
Anterior cord syndrome: causes and features
- results from injury to ventral spinal cord
- bilateral paresis and paralysis and decrease pain and temp distal to lesion
- intact vibration, proprioception and crude touch (post column spared)
Anterior spinal cord causes
- cervical flexion injuries causing cord contusion
- laceration of ant. spinal cord by fragments from vert. fx’s
Central spinal cord syndrome: causes and features
- due to hyperextension of neck
- decreased pain/temp, and muscle weakness in UE bilaterally
- legs affected to a lesser degree
Brown-Sequard syndrome
- mostly due to GSW or stab wound that injures 1/2 of spinal cord
- loss of motor fxn and proprioception/vibration ipsilateral to side of lesion
- loss of pain/temp contralateral to side of lesion
- bowel/bladder conserved
Cauda-Equina syndrome
- severe injuries below L2 level of spine: injures lumbar, sacral and coccygeal nerve roots
- decrease sensation over buttocks, perieneal, bilateral leg pain/weakness, bowel/bladder dysfxn, decreased rectal sphincter tone
