Lecture 9: Concussion and Spinal Cord Disorders Flashcards Preview

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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



-cognitive rest
-physical rest


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