Spinal cord injury

Question 1

Primary injury

Answer 1

initial traumatic injury typically results in damage to the BONES and LIGAMENTS of the spinal column

Question 2

things that will cause ischemia/infarct

Answer 2

compression
hemorrhage
traumatic vasospasm

Question 3

secondary injury

Answer 3

CORD EDEMA, and as a result of the rigid confines of the vertebral canal, increased pressure within that canal.

MAX PRESSURE within 4-6 days= high risk of ischemia

Question 4

pathologic consequences of cord injury

Answer 4

• nitric oxide synthase

release of excitotoxic amino acids

release of CALCIUM

Oxidative stress

lipid peroxidation

Question 5

A complete cord transection will result in:

Answer 5

disruption of afferent and efferent signals

Question 6

Partial cord disruption:

Answer 6

central cord syndrome

anterior cord syndrome

brown-sequard syndrome

cauda-equina syndrome

Question 7

cervical nerves:

Answer 7

diaphragm
deltoids
biceps
wrist extensors
rotates arm
triceps
bends fingers

Question 8

thoracic nerves

Answer 8

spreads fingers
chest muscles
abdominal muscles
muscles in the back

Question 9

lumbar nerves

Answer 9

hip muscles
thigh muscles
knee muscles
foot muscles

Question 10

sacral nerves:

Answer 10

bladder and bowel
sexual function

Question 11

Brown-Sequard syndrome

Answer 11

below injury level, motor weakness or paralysis on one side of the body (hemiparaplegia). loss of sensation on the opposite side (hemianesthesia)

Question 12

Anterior cord syndrome

Answer 12

Below injury level, motor paralysis, and loss of pain and temperature sensation. Proprioception, touch, and vibratory sensation are preserved.

Question 13

posterior cord syndrome

Answer 13

below injury level, motor function preserved, loss of sensory function: pressure stretch and proprioception

Question 14

central cord syndrome

Answer 14

Results from cervical spinal injuries. Greater motor impairment in upper body compared to lower body. variable sensory loss below level of injury.

Question 15

conus medullaris syndrome

Answer 15

follows damage to the lumbar nerve roots and conus medullaris

bowel and bladder are flexia- loss of motor and sensory function

Question 15

cauda eauina syndrome

Answer 15

occurs from injury to the lumbosacral nerve roots below the conus medullaris

areflexia of the bowel, bladder and lower reflexes

Question 16

below T6=

Answer 16

paraplegia

Question 17

features of neurogenic shock

Answer 17

diminished effect of sympathetic pathways

loss of vasomotor tone + diminished sympathetic innervation of the heart

vasodilation of blood vessels (visceral and lower extremity)

pooling of blood leading to HoTN and bradycardia

treatment: fluid resuscitation, vasopressors, atropine

Question 18

spinal shock:

Answer 18

temporary features of lower motor neuron lesions (flaccidity, paralysis, loss of reflexes) w resolution within 24 hrs

Question 19

spinal cord perfusion pressure:

Answer 19

SCPP= MAP- CSFP

Question 20

_____ is the first step in the tx of HoTN in a pt w spinal cord injury

Answer 20

intravascular volume

Question 21

vasodilation treat w

Answer 21

volume
alpha agonists

Question 22

hotn and bradycardia

Answer 22

dopamine
NE

Question 23

persistent bradycardia may be seen in high cervical lesions C1-C5

Answer 23

anticholinergics
pacemaker

Question 24

autonomic hyperreflexia

Answer 24

Neurologic disorder that occurs in association w the resolution of spinal shock and return of spinal cord reflexes cutaneous or visceral stimulation such as distention of urinary bladder or rectum below level of spinal cord transection initiates afferent impulses stimulation elicits a reflex sympathetic response over splanchnic nerves

Question 25

autonomic hyperreflexia reflex during general anesthesia

Answer 25

above T6

Question 26

no reflex d/t hyperreflexia below

Answer 26

T10 dermatome

Question 27

treatment of autonomic hyperreflexia

Answer 27

ganglionic blocking drugs: trimethaphan alpha agonists-phentolamine vasodilators- Nitroprusside, NTG