SCI

Question 1

which part of the SC is more protected d/t its blood supply?

Answer 1

posterior
posterior spinal artery has 2 branches and supplies 1/3 of SC

Question 2

what part of the spinal cord is damaged in ALS?

Answer 2

anterior horn cells (motor neurons)
Wallerian degeneration

Question 3

where does the spinothalamic tract cross?

Answer 3

anterior commissure of the SC immediately/1-2 levels above enter

Question 4

if there is a stroke at the thalamus, where will pain & temp deficits be?

Answer 4

contralateral

Question 5

where does the DCML cross?

Answer 5

caudal medulla
(internal arcuate fibers)

Question 6

how will DCML be lost with a lesion at the SC?

Answer 6

ipsilateral

Question 7

which structure does all sensory integration for the entire body (except face)?

Answer 7

ventral posterior lateral nucleus of thalamus

Question 8

where does the corticospinal tract cross?

Answer 8

medulla (cervical medullary junction)
pyramids

Question 9

which spinal levels do the parasympathetic NS?

Answer 9

cervical and sacral

Question 10

which spinal levels do the sympathetic NS?

Answer 10

T1-L3

Question 11

what sx are indicative of a SC lesion?

Answer 11

bilateral sx
B/B involvement
leg stiffness
neck or back pain
Lhermitte or Uhthoff
sensory level
tight band sensation across trunk/torso

Question 12

tight band sensation across trunk/torso could indicate what condition?

Answer 12

transverse myelitis (–> MS)

Question 13

what is the 2 most common complete SCI?

Answer 13

1 C5
2 C4

Question 14

what spinal levels lead to quadriplegia?

Answer 14

C1-T2

Question 15

what spinal levels lead to paraplegia?

Answer 15

T3 and down

Question 16

what is the ASIA scale?

Answer 16

assesses the level of involvement of a SCI
assesses prognosis
should be done w/i 24-48 hours post SCI

Question 17

what are the UE motor tests on the ASIA?

Answer 17

C5 elbow flexors
C6 wrist extensors
C7 elbow extensors
C8 finger flexors
T1 finger abductors

Question 18

what are the LE motor tests on the ASIA?

Answer 18

L2 hip flexors
L3 knee extensors
L4 DF
L5 great toe extensors
S1 PF

Question 19

what determines if a SCI is complete or not?

Answer 19

if there is voluntary anal contraction = not complete

Question 20

how is motor testing performed on the ASIA scale?

Answer 20

all done in supine

Question 21

what are the grades of SCI on the ASIA scale?

Answer 21

A = complete (S4-5 impaired)
B = sensory incomplete (no motor)
C = motor incomplete: <1/2 key mm functions & mm grade < 3
D = motor incomplete: at least 1/2 key mm functions & mm grade ≥ 3
E = normal

Question 22

sx of spinal shock

Answer 22

immediate flaccidity & loss of sensory and autonomic function BELOW level of lesion
atonic bladder
loss of vasomotor control

Question 23

how to determine if person is out of spinal shock?

Answer 23

anal wink/reflex returned

Question 24

autonomic dysreflexia occur in a SCI above ____ level

Answer 24

T5

Question 25

SCI sx after spinal shock

Answer 25

increased reflexes spasticity below lesion level pathological pyramidal reflexes spastic bladder paralyzed legs w/ contractures autonomic dysreflexia (above T5)

Question 26

which spinal level SCI is dependent with verbal communication?

Answer 26

C1-C3

Question 27

what is autonomic dysreflexia?

Answer 27

exaggerated sympathetic response to noxious stimuli below lesion (for SCI above T5)

Question 28

sx of autonomic dysreflexia

Answer 28

hypertension sweating flushing bradycardia

Question 29

autonomic dysreflexia is usually due to ___ injury of SCI

Answer 29

complete transverse

Question 30

risk of autonomic dysreflexia is increased after recovery from

Answer 30

spinal shock

Question 31

T/F: fertility is maintained in both F and M with SCI

Answer 31

F just F

Question 32

leading causes of death of SCI pts

Answer 32

sepsis pneumonia respiratory failure

Question 33

when is the highest rate of lowered life expectancy after a SCI?

Answer 33

1st year

Question 34

what is the most common level for cervical spondylosis?

Answer 34

C5-C6

Question 35

cervical spondylosis causes ____ below the lesion and ___ at the level of the lesion

Answer 35

below - myopathy @ - radiculopathy

Question 36

C spine injury has ___ deficits at the level of the lesion and ____ below

Answer 36

@ - UMN below - LMN

Question 37

motor neuron injuries (ex: ALS) has ____ deficits at the level of the lesion and ____ below

Answer 37

@ - LMN below - UMN

Question 38

what is a sign of permanent injury to the SC and requires surgery?

Answer 38

cord signal change

Question 39

what is the most common non-traumatic SCI?

Answer 39

cervical spondylotic myelopathy

Question 40

sx of cervical spondylotic myelopathy

Answer 40

pain burning weakness numbness tingling B/B dysfunction !! Lhermitte's phenomenon !! more fine motor involvement

Question 41

a positive Hoffman's sign indicates a lesion where?

Answer 41

C spine

Question 42

what is the most common level to have a SC met?

Answer 42

thoracic

Question 43

what is the only SCI treated with steroids?

Answer 43

SC mets

Question 44

primary tumor sites that go to SC mets

Answer 44

lung breast prostate kidney thyroid gut

Question 45

red flags of epidural abscess

Answer 45

fever back pain diabetes

Question 46

an epidural abscess will be ___ shaped

Answer 46

crescent

Question 47

subacute combine degeneration is a SC syndrome that involves the _____ and _____ tracts

Answer 47

posterior column and corticospinal

Question 48

posterolateral column syndrome is usually caused by _____ deficiency

Answer 48

B12

Question 49

what is the model disease for posterior column syndrome?

Answer 49

neurosyphilis (Tabes dorsalis) *absent reflexes but preserved strength

Question 50

hemicord syndrome sx

Answer 50

ipsi UMN weakness below lesion ipsi LMN weakness at lesion level ipsi loss of vibration & proprioception CONTRA loss of pain and temp 1-2 levels below ipsi nerve root pain ipsi impaired sweating

Question 51

NMO can lead to what kind of SCI?

Answer 51

central cord syndrome

Question 52

Chiari malformation can cause ___ which is a central cavitation of the SC

Answer 52

syringomyelia

Question 53

where is syringomyelia most common?

Answer 53

C spine

Question 54

syringomyelia will have a ____ distribution of weakness and reflex loss

Answer 54

cape *in hands and arms

Question 55

anterior cord syndrome is usually due to

Answer 55

anterior spinal artery stroke

Question 56

what tracts are affected with anterior cord syndrome?

Answer 56

CST STT

Question 57

conus medullaris & cauda equina syndrome presentation

Answer 57

preserved UE impaired B/B function absent reflexes