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Unit 14 > SC etiology/ASIA > Flashcards

SC etiology/ASIA Flashcards

1
Q

Demographic shift of SCI

A

average age is older bc the population is living longer and having falls

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2
Q

profile of someone likely to have traumatic SCI based on statistics

A

average age 43

white

males

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3
Q

Most common etiology of traumatic SCI

Second?

Third?

A

MVA’s

Falls

GSW

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4
Q

are there more complete or incomplete traumatic SC injuries?

tetraplegia or paraplegia?

A

incomplete

Tetraplegia

Paraplegia is next most common

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5
Q

Acute care and rehabilitation stays compared to in the past are what?

A

shortening. Average day is 11 in acute care

average is 31 days in rehabilitation

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6
Q

What is the number one cause of death in the SCI population?

What about things directly related to SCI?

A

Heart disease, just like the regular population

Pneumonia, septicemia (sepsis)

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7
Q

Subluxation/dislocation, fracture dislocation and compression fracture are all bony or spinal cord injuries?

A

Bony

Contusions, lacerations (penetrating wounds), transections (severed cord) , shearing and traction are direct injuries to the spinal cord

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8
Q

Hyperflexion is most common at what level?

A

C5,6

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9
Q

Vertical Compression most common with what kind of accidents, most common level?

A

Diving accidents

C4-5 complete

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10
Q

Hyperextension most commonly creates what kind of SC defect?

A

Central cord

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11
Q

Compression with extension most common occurs when?

A

striking chin or forehead

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12
Q

the most common types of C spine injuries are lower or upper Cspine?

A

lower

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13
Q

Why are thoracic injuries less common and less likely to be complete

What level are they most common at? why?

A

Ribs provide stability T1-T10

T12-T1 is the most common site because of the loss of stability provided by the ribs

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14
Q

Results of lumbar spine SCI injuries are generally complete or incomplete?

A

incomplete! the vertebral bodies are much larger so they create more protection of the SC vs. other levels. You’re aslo talking about the cauda equina rather than the spinal cored itself leading it to be more of a peripheral injury vs. central cord.

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15
Q

Explain why we can’t ever say for certain if someone is “complete”

A

we can’t go into the SC and look at it and see if one little nerve is sneaking by.

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16
Q

name some other common causes of SC injury after direct damage?

A

impingement of bony or soft tissue

Transection (rare)

Interruption of vascular supply or hemorrhagic necrosis

Trauma leading to bruising or hemorrhage

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17
Q

transections are most commonly found with with what kind of injury?

A

gunshot or stabbing

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18
Q

better emergency management has lead to what in terms of kind of SC injuries?

A

more incomplete than complete

Proper handling, adequate ventilation and circulation, radiologic investigation, immobilization of the spine, bolus of steroids = better emergency management = better short term outcomes

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19
Q

How long does spinal shock normally resolve after

A

24 hrs. its transient

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20
Q

Define spinal shock

A

temporary stop of all spinal reflexes below the level of the injry. No motor, no sensation, no reflexes, no autonomic function, no nothing

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21
Q

Role of methylprednisolone in SCI

A

steroid, to be initiated within 8 hours of injury to minimize secondary changes. Reduces sources of poor perfusion to the cord

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22
Q

True or false, surgery is always completed in these patients

A

no! but sometimes boney things need to be fixed to ensure no more damage occurs, OR to decompress the SC

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23
Q

Goal of surgery

A

minimize secondary destruction to SC following injury through Decompression and stabilization

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24
Q

Decompression and stabilization are what?

A

the two major goals of surgery for SCI pts

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25
Q

When someone gets a fusion what will you see in their motion?

A

Hypermobility above and below the level of the fusion, your body has to get the motion from somewhere

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26
Q

really important piece of pt education post spinal surgery

A

it didn’t fix your spinal cord, it stabilized everything. Get them prepared to live at WC level

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27
Q

What determines if someone gets an external stabilization device

A

surgical or non surgical intervention

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28
Q

AD is seen with lesions where

A

above T6

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29
Q

what is the first thing pts may experience w/ AD

A

HA

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30
Q

sx of AD

A 
increased BP
bradycardia
HA
sweating
congestion
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31
Q

explain AD

A

noxious stimuli below the lesion, pt generally cannot feel, leading to excessive sympathetic responses –> increased CO –> elevated BP –>stimulation of barroreceptors –> increased parasympathetic activity –> bradycardia and vasodilation above the lesion

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32
Q

quick “tx” for AD

A

remove offending stimulus!

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33
Q

possible consequences of AD are generally due to what?

A

super high BP

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34
Q

tx of AD

A

remove noxious stimulus

Sit them up so their legs are dependent to decrease BP

Check vitals

Get help!!

Immediate attention at the first signs of sx is essential

Educate patients on AD beffore it happens

35
Q

How long does it take for someones BP to return to normal after noxious stimuli has been removed in someone with AD?

A

almost immediately

36
Q

If one leg is red and huge and one leg is normal what is the patient probably experiencing

A

DVT common in acute stage of SCI. Risk for PE causing death

37
Q

why are PE’s even more dangerous in SCI patients

A

they may lack sensation in the trunk and won’t be able to feel chest pain, as well as they probably already have a shallow breathing pattern so it won’t be something to tip off the medical team.

38
Q

Why are SCI pts more susceptible to OA?

A

no WB/loading, muscles aren’t firing to facilitate normal breakdown and build up of bone

39
Q

who is at extremely high risk of OA in SCI population

A

post menopausal women

40
Q

what is the trend of OA in SCI pts

Most aggressive loss is when?

A

gradually progresses for the first few years and then plateaus.

Most aggressive loss within first 3-6 months

41
Q

When is the highest occurance of HO?

A

first four months

42
Q

Resulting disability from HO

A

Decreased ROM
Increased risk of pressure soars
functional limitations

43
Q

etiology of HO?

A

Unknown

44
Q

What is the most common complication after SC injury?

A

pressure ulcers

45
Q

Focus tx on what for pressure ulcers?

A

prevention!

46
Q

Wt shifts should be how often

Bed:
Chair:

A

Bed: every 2 hrs
Chair: every 30 min

47
Q

Tetraplegia/quadraplegia defined as what?

Does not include what?

Results in impairment in what?

A

impairment or loss of motor and/or sensory funciton in segments of the cspine.

Does NOT include brachial plexus lesions or peripheral nerve injuries

impairment in arms, trunk, legs and pelvic organs

48
Q

Paraplegia definition

Does NOT include what

Spared what?

A

impairment or loss of motor and or sensory function in thoracic, lumbar, or sacral segments of the spinal cord. Does not include lubosacral plexus lesions or peripheral nerve injures

Spared: arms. Trunk, legs and pelvis may be involved

49
Q

Radiographic level where the greatest vertebral damage is found is called what?

A

skeletal/orthopedic level

50
Q

Neurological level definition

A

most caudal segment of the SC with normal sensory AND motor function on both sides of the body (ASA scoring)

51
Q

ISNCSCI is what?

how many parts

what is it for?

A

ASIA exam

3 parts: sensory, motor, anorectal

Used to categorize pts according to level and severity of injury

52
Q

name the 6 steps of ASIA scoring

A

Determine sensory for both sides
Determine motor for both sides
Determine neurological level of injury
Determine whether the pt has complete or incomplete injury
Determine the ASIA impairment scale grade
Determine a zone of partial preservation

53
Q

Sensory level definition

A

most caudal, intact dermatome for both pin prick and light touch sensation.

Will have one for R and one for L

54
Q

pin prick scoring of 2 (normal) has to be what?

A

pt must be able to tell the difference btwn sharp and dull and intensity has to be the same as the control area (face)

55
Q 
sensory grading 
0
1
2
#*
A

0: absent
1: altered
2: normal

Can also be NT
#* sensitivity difference is due to something else (DM)
56
Q

C5-S1 key muscle groups

A 
C5: elbow flexors
C6: wrist extensors
C7: elbow extensors 
C8: finger flexors 
T1: ABD digiti minimi
L2: hip flexion 
L3: knee extension
L4: DF
L5: EHL
S1: PF
57
Q

AIS B to C nuance

A

non-key muscle that is functional more than 3 levels below the motor level can change the classification to an AIS C

58
Q

motor screen

A

MMT but no plus or minuses

59
Q

motor testing for the trunk

A

you cant isolate the spinal segments so you just use the sensory level

60
Q

Sacral sensation

A

light touch, pin prick and DAP

61
Q

Sacral motor function

A

VAC: voluntary contraction of the external sphincter upon digital stimulation

62
Q

How are sacral segments scored

A

motor and sensory are both a yes or a no

63
Q

sensory level is defined as what

A

most caudal dermatome for BOTH light touch and pin prick are 2’s. Separate for R and L

64
Q

Motor level is defined as what.

What does intact in this case mean?

A

loest key muscle function that has a grade of at least 3, providing the key muscle functions above that level are intact/they have a grade of 5

Intact means: 5, the grades above the level must be 5, the level itself has to be at least a three

Separate for R and L

65
Q

single neurological level (SNL, or NLI) of the injury is defined as what.

A

most caudal segment of the SC with intact sensation and antigravity muscle function strength (3 or greater)

most rostral of the total two sensory and two motor levels (R and l for both)

66
Q

Complete SCI is defined as what

A

absence of motor AND sensory function in the lowest sacral segment (S4-5)

67
Q

Incomplete injury definition

What are the two things someone must have one of to be considered incomplete

A

Must have one of the following to be considered incomplete

1) LT or PP at S4-5 dermatome point OR DAP
2) voluntary (not reflex) contraction of external anal sphincter upon digital examination; also called the VAC

68
Q

ASI A description

A

complete injury

no VAC and DAP. AKA no motor or sensory function preserved in lowest sacral segments

69
Q

What does “NOOOON” indicate

A

complete injury

70
Q

ASI B is _____ incomplete

Describe

A

ASI B is SENSORY incomplete

No motor preserved below neurological level including absence at S4-5 (no motor can be preserved more than 3 levels below the motor level on either side)

MUST HAVE: LT or PP at S4-5 or DAP

71
Q

AIS C description

What about more than 1/2 key muscles below the neurological level?

A

motor function is preserved below neurological level of injury

Must have EITHER of the following MOTOR components

1) VAC
2) sacral sensation sparing PLUS motor function spared greater than 3 levels below the motor level of injury, key or non key

More than 1/2 of the key muscles below the neurological level of injury must have a grade of <3

72
Q

AIS D description?

What about more than 1/2 key muscles below the neurological level?

A

Must have EITHER of the following MOTOR components

1) VAC
2) sacral sensation sparing PLUS motor function spared greater than 3 levels below the motor level of injury, key or non key

More than 1/2 of the key muscles below the neurological level of injury must have a grade of >3

73
Q

ASI E

A

motor and sensation normal in all segments

only utilized if pt had prior deficits it implies full neurologic recovery of function

74
Q

Whom would motor ZPP be given to?

A

someone w/o VAC

75
Q

Whom would sensory ZPP be given to?

A

someone w/o LT, PP, or DAP at S4-5

76
Q

Anterior cord syndrome

Etiology

Losses

Preserved

Prognosis

A

Etiology: flexion injuries, direct damage by bony fragment or disc compression, vascular insufficiency of anterior spinal artery

Complete paralysis w/hyperesthesia and hypoalgesia below the level of lesion

Preserved: DCML (includes 2pt discrimination)

Prognosis: poor, 10-20% of muscle recovery

77
Q

Brown Sequard Syndrome

Etiology

Losses

Preserved

Prognosis

Likely you see ____with this?

A

Loss of 1/2 of SC

Etiology: stabbing, GSW

Losses: motor paralysis and loss of DCML, 2pt discrimination and stereognosis ipsilaterally. ALS loss contralaterally

Preserved: opposite of loss

Prognosis: best prognosis for ambulation of all the clinical syndromes

Likely you see SPASTICITY below the level of the lesion

78
Q

Central cord syndrome

Etiology

Presentation

Prognosis: +’s and -‘s

A

Etiology: falls, older adults, cervical hyperextension and spondolysis

Presentation motor and sensory loss in UE&raquo_space; LE

Prognosis: hand function&raquo_space; arm function, early motor recovery is a good sign, young pt is a good sign, no spasticity, absence of LE motor impairment at rehab admission, UE strength improvement in rehab

Negative: older adults are 41% likely to ambulate

79
Q

What is the most common SCI clinical syndrome

A

central cord

80
Q

What has the best ambulation prognosis out of the clinical syndromes.

Exception?

A

Brown Sequard

Exception is cauda equina bc this is nerve roots not the SC itself

81
Q

Least common SCI clinical syndrome?

Etiology:

Losses:

Preservation

Ambulation?

A

posterior cord syndrome

Etiology: neck hyperextension injuries, posterior spinal artery occlusion, tumors, disc compression, vitamin B12 deficiency

Losses: loss of DCML below injury

preservation: motor and ALS

May be able to walk but they’ll have no balance due to loss of proprioception, light touch etc.

82
Q

Conus medullaris syndrome

Injury to what?

Etiology

Presentation?

A

Injury of sacral cord and lumbar nerve roots

Etiology: trauma, tumo

Mix of UMN and LMN sx: Saddle anesthesia, areflexic bladder and bowel, variable degrees of LE weakness

83
Q

Cauda Eqina Syndrome

Injury to what?

Considered what kind of injury?

Etiology?

Prognosis?

A

Injury to the lumbosacral nerve roots

Considered PURE LMN: saddle anesthesia, areflexic bowel and bladder, asymmetric LE weakness

Etiology: trauma, tumors, spinal stenosis, infection, disc compression, post surgical epidural hematoma

Prognosis: better than all other SCI’s bc the nerve roots have the ability to regenerate

Unit 14 (6 decks)

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