Neuromuscular and nervous systems clinical application- Central Cord Syndrome

Question 1

what is central cord syndrome? what is the typical MOI resulting in central cord syndrome?

Answer 1

an incomplete spinal cord lesion that most often results from cervical hyperextension injury

Question 2

symptoms of central cord syndrome are __ to damage of the central aspect of the spinal cord

Answer 2

secondary

Question 3

central cord syndrome typically occurs from a __ but can occur from other forms of trauma such as MVA

Answer 3

fall

Question 4

central cord syndrome typically occurs from a fall but can occur from other forms of trauma such as __

Answer 4

MVA

Question 5

what structure does a cervical hyperextension injury typically injure?

Answer 5

ligamentum flavum

Question 6

in central cord syndrome the spinal cord sustains __ into the __ __ matter that causes damage to the __ located tracts (spinothalamic, cerebrospinal, lateral tracts)

Answer 6

bleeding; central gray; centrally

Question 7

what is an alternative MOI that causes central cord syndrome that is not traumatic in nature?

Answer 7

anterior compression of the spinal cord due to osteophyte formation

Question 8

in central cord syndrome, studies often reveal __ disruption in the __ columns at the level of injury with preservation of the __ __

Answer 8

axonal; lateral; gray matter

Question 9

potential contributing factors (5) in the development of central cord syndrome?

Answer 9

cervical spondylosis
narrowing or congenital defect of the spinal canal
tumor
rheumatoid arthritis
syringomyelia

Question 10

central cord syndrome predominantly affects the population over __ years of age with greater incidence in men or women?

Answer 10

50; men

Question 11

central cord syndrome presents with motor or sensory loss that is greater in the __ extremities than __ extremities and is more severe __ in the __ extremities

Answer 11

motor; UE; LE; distally; UE

Question 12

why is motor loss greater in the upper extremities than lower extremities and is more severe in the distal upper extremities due to the damage that occurs where?

Answer 12

centrally in the spinal cord

Question 13

motor deficits are greater than sensory deficits in central cord syndrome, with sensory loss often __ and found at the __ of the lesion

Answer 13

limited and found at the level of the lesion

Question 14

what segments of the spinal cord are typically affected by central cord syndrome? how?

Answer 14

cervical, thoracic and lumbar segments proceed medially in order towards the center of the spinal cord

Question 15

why aren’t the sacral segments of the spinal cord typically affected by central cord syndrome?

Answer 15

they are located laterally w/in the spinal cord

Question 16

what imaging studies (3) can be used to confirm/diagnose central cord snydrome?

Answer 16

MRI
CT scan
X-rays

Question 17

what is MRI used to specifically assess (1) as it relates to central cord snydrome?

Answer 17

spinal cord impingement from bone or disk

Question 18

what is a CT scan used to specifically assess (2) as it relates to central cord snydrome?

Answer 18

spinal canal compromise
degree of impingement

Question 19

what is x-ray (3) used to specifically assess as it relates to central cord snydrome?

Answer 19

potential fractures, dislocations and degree of spondylotic deterioration

Question 20

what additional information (2) should be obtained to assist in confirming the diagnosis of central cord syndrome outside of MRI, CT scan or x-ray?

Answer 20

PMH
MOI

Question 21

what subjective history (9) should be documented when examining a patient diagnosed with central cord syndrome?

Answer 21

PMH
medication
family history
current symptoms
MOI
social history/habits
occupation
leisure activities
social support system

Question 22

what objective measurements/tests (15) should be performed when examining a patient diagnosed with central cord syndrome?

Answer 22

A&O
pain- assessment of neuropathic pain
posture-resting and dynamic

ventilation, respiration and circulation (breathing patterns, ausculation of lungs and heart)
aerobic capacity/endurance (autonomic responses to positional changes, vital signs with rest/activity)

A/PROM
ASIA motor exam, muscle tone exam
DTRs and pathological reflexes (Babinski, ATNR), analysis of reflex movement patterns
motor function: equilibrium and righting reactions, posture and balance in sitting
skin assessment, ASIA sensory exam

gait/locomotion/balance: static/dynamic balance in sit/stand, safety during gait with/without AD, Berg balance, Tinetti performance oriented mobility assessment, wheelchair management

analysis of current/potential barriers or hazards in environment, home, work
community and work reintegration
assistive and adaptive devices
assessment of functional capacity: FIM, Barthel index

Question 23

what gait, balance and mobility tests (3) should be administered during examination of a patient with central cord syndrome?

Answer 23

Berg balance
Tinetti performance oriented mobility assessment (balance and gait)
wheelchair management

Question 24

what assessments of functional capacity (2) should be administered during examination of a patient with central cord syndrome?

Answer 24

FIM
Barthel index

Question 25

each patient with central cord syndrome presents differently based on __ and __ of injury to the spinal cord

Answer 25

location, extent

Question 26

what are the potential side effects and complications (5) of central cord syndrome?

Answer 26

dysreflexia spasticity neurogenic bowel and bladder allodynia pressure ulcers

Question 27

when are rehabilitation services initiated for a patient with central cord syndrome?

Answer 27

once the patient is medically stable

Question 28

what should medical management of a patient with central cord syndrome include (5)?

Answer 28

physiatry PT OT vocational counseling social services

Question 29

what pharmacological aintervention should be administered within 8 hours of injury to assist with neurological recovery?

Answer 29

methylprednisolone

Question 30

methylprednisolone should be administered within __ hours of injury to assist with __ recovery

Answer 30

8; neurological

Question 31

what other pharmacological interventions (4) may be prescribed to patients with central cord syndrome?

Answer 31

blood pressure medication antispasticity medication prophylactic anticoagulants antidepressants

Question 32

why might blood pressure medication be prescribed to a patient with central cord syndrome?

Answer 32

to combat autonomic dysreflexia

Question 33

why might antispasticity medication be prescribed to a patient with central cord syndrome?

Answer 33

treatment of spasticity

Question 34

why might anticonvulsant medication be prescribed to a patient with central cord syndrome?

Answer 34

treatment of neurogenic pain

Question 35

what should physical therapy include (8) for a patient with central cord syndrome based on current patient functional status?

Answer 35

patient and caregiver education ROM strengthening endurance activities balance training proximal stabilization exercises functional mobility adaptive devices

Question 36

if a patient with central cord syndrome ambulates, what type of assistive device might initially be indicated since hand function is usually poor for grasp?

Answer 36

a platform attachment walker

Question 37

if a patient with central cord syndrome ambulates, a platform attachment walker might initially be indicated since __ function is usually poor for __?

Answer 37

hand; grasp

Question 38

surgical intervention for central cord syndrome is __

Answer 38

rare

Question 39

although surgical intervention for central cord syndrome is rare, it may be indicated when (2)?

Answer 39

compression within the spinal cord persists or progress ceases without cause

Question 40

what type of physical therapy may be warranted for patients with central cord syndrome based on current functional status?

Answer 40

outpatient physical therapy w/ HEP modification as necessary

Question 41

what should a patient with central cord syndrome's HEP generally include based on current functional status?

Answer 41

continuation of exercise, endurance training and functional mobility

Question 42

what is the likely outcome of a course of physical therapy for a patient with central cord syndrome?

Answer 42

PT can assist to attain max functional outcome based on level and extent of injury

Question 43

physical therapy can assist to attain __ __ __ based on level and extent of injury

Answer 43

max functional outcome

Question 44

physical therapy can assist to attain max functional outcome based on __ and __ of injury

Answer 44

level and extent

Question 45

overall outcome of a patient with central cord syndrome is based on __ , __, __ and __ __ __

Answer 45

age, motivation, compliance and extent of injury

Question 46

what type of injury is the most common type of incomplete spinal cord lesion?

Answer 46

central cord syndrome

Question 47

the majority of patients with CCS will __ and roughly half will regain __ and __ control as well as some __ function

Answer 47

ambulate; bowel and bladder; hand

Question 48

the __ of patients with CCS will ambulate and roughly __ will regain b&b control as well as some hand function

Answer 48

majority; half

Question 49

__ patients do not tend to recover as well as __ patients

Answer 49

older; younger

Question 50

what do favorable long-term prognostic factors for a good outcome in a patient with CCS include (3)?

Answer 50

early hand function improvement in strength in all extremities during inpatient stay little to no lower extremity involvement

Question 51

what is a common differential diagnosis of central cord syndrome?

Answer 51

anterior cord syndrome

Question 52

anterior cord syndrome typically effects __-__ of the spinal cord

Answer 52

two-thirds

Question 53

what are common MOIs for anterior cord syndrome

Answer 53

cervical flexion injury anterior spinal artery embolization

Question 54

anterior spinal artery embolization is a common MOI for what type of spinal cord lesion?

Answer 54

anterior cord syndrome

Question 55

cervical flexion injury is a common MOI for what type of spinal cord lesion?

Answer 55

anterior cord

Question 56

anterior cord syndrome involves damage to the __ and __ tracts of the spinal cord and preservation of the __ columns

Answer 56

spinothalamic and corticospinal; posterior columns

Question 57

what kinds of impairments result from damage to the spinothalamic and corticospinal tracts associated with anterior cord syndrome?

Answer 57

complete loss of motor function as well as pain and temperature below the level of the lesion

Question 58

damage to the spinothalamic and cortcospinal tracts associated with anterior cord syndrome result in complete loss of __ function as well as __ and __ sensation __ the level of the lesion

Answer 58

motor; pain and temperature; below

Question 59

preservation of the posterior columns associated with anterior cord syndrome allow for intact __ and __

Answer 59

vibration and proprioception

Question 60

what spinal cord syndrome has the worst prognosis out of all spinal cord syndromes?

Answer 60

anterior cord syndrome