Spinal Cord Injuries Flashcards
What can cause complete cord transection syndrome?
Trauma Infarction Transverse myelitis Abscess Tumour
What are the clinical features of complete cord transection syndrome?
Compelte loss of sensation and paralysis of muscles below the lesion.
Spinal shock and autonomic dysfunction with higher lesions
Hypotensiondue to loss of sympathetic control
Priapism- prolonged sustained erection
What can cause brown sequard syndrome?
Penetrating trauma Fractured vertebrae Tumour Abscess Multiple sclerosis
What are the clinical features of brown sequard syndrome?
Ipsilaterally to injury:
Loss of motor function
Loss of dorsal column modalities
Contralaterally to injury: loss of spinothalamic tract modalities
What can cause anterior cord syndrome?
Often occurs as a result of a flexion injury which leads to fractures or dislocations of vertebrae or herniated discs.
Can also be due to injury to anterior spinal artery- vascular or atherosclerotic disease
What are the clinical features of anterior cord syndrome?
Flaccid paralysis below level of lesion
Loss of pain/ temperature
Autonomic dysfunction- bowel, bladder, sexual function
What are the causes of central cord syndrome?
Trauma- hyperextension injury of cervical spine in elderly
Hyperflexion injury of cervical spine in younger patients
Disruption of blood flow to spinal cord Cervical spinal stenosis Degenerative spinal disease Syringomyelia Central canal ependymoma
What is syringomyelia?
Unknown aetiology
Development of a cyst within the central canal
Initial symptoms arise in obliteration of spinothalamic fibres decussating in white commisure- causes loss of sensitivity to pain and temperature in cape like distribution.
Sensitivity to light touch and proprioception is preserved
What are the clinical features of central cord syndrome?
Motor loss in arms more than trunk. No motor loss in legs
Distal motor fibres are affected first, then proximal.
Bladder dysfunction and urinary retention
What are the causes of posterior cord syndrome?
Very rare
Normally due to chronic pathological processes rather than trauma. Eg Spondylosis Spinal stenosis Infectoins Vit B12 deficiency
Occlusion/infarction of paired posterior spinal arteries
What are the clinical features of posterior cord syndrome?
Isolated loss of dorsal column modalities
What is the immediate management of spinal cord injuries?
ABCDE approach
Assume spine injury if head injury present, unconscious or confused, spinal tenderness, extremity weakness, loss of sensation
Consider intubation for injuries at C5 or above
Use log roll, backboard and rigid C collar.
Address hypoxia, hypotension and hypothermia, complete neurological examination and assess bladder volume and distension- insert urinary catheter
