Flashcards in Lecture 9: Concussion and Spinal Cord Disorders Deck (22)
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Concussion definition
disturbance in brain fxn caused by direct or indirect force to the head
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Concussion presentation
fxnl rather than structural injury that can affect somatic, cognitive and affective domains; sleep disturbances also common
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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
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Dx of concussion
- must have temporal rltnshp btwn an appropriate mechanism of injury and onset or worsening of sx
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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
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Initial Eval of Concussions
-begin at cervical spine/site of injury
-monitor for deterioration of sx's over several hours
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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
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Type of imaging
CT = initial choice
MRI
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Management
-cognitive rest
-physical rest
-meds/intervention
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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
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Clinical presentation
-urinary retention/constipation/ilues
-hypotension, bradycardia
-hemiplegia, hemiparesis (sparing face)
-paraplegia, paraparesis
-quadriplegia, quadriparesis
-loss of sensation --> unilateral or bilateral
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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
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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
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High cervical complete transection
-quadriplegia, anesthesia in trunk and all extremities, and resp. failure
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Thoracic or Lumbar injuries
-paraplegia, loss of sensation in LE
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Determination of level of complete transection injury
-determine dermatomal level which sensation is lost
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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
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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)
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Anterior spinal cord causes
-cervical flexion injuries causing cord contusion
-laceration of ant. spinal cord by fragments from vert. fx's
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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
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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
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