Spinal Cord Injury Flashcards
(93 cards)
1
Q
What is The Spinal Cord?
A
long, cylindrical structure made up of nervous tissue that extends from the brainstem (specifically the medulla oblongata) down through the vertebral column
main communication highway between the brain and the body
part of the central nervous system (CNS), along with the brain, and it also plays a role in reflexes
2
Q
How Long is the Spinal Cord?
A
In adults: About 42 to 45 cm long (around 17 to 18 inches)
typically ends at the level of L1 to L2 vertebrae in adults, tapering off into a structure called the conus medullaris, followed by the cauda equina
3
Q
Vertebral column and spinal nerve levels:
A
There are 8 cervical spinal nerves but only 7 cervical vertebrae.
C1–C7 spinal nerves exit above their corresponding vertebra.
C8 exits below C7 (between C7 and T1).
From T1 downward, spinal nerves exit below their corresponding vertebra.
4
Q
cervical vertebrae:
A
C1-C7
5
Q
thoracic vertebrae:
A
T1-T12
6
Q
lumbar vertebrae:
A
L1-L5
7
Q
sacral vertebrae:
A
S1-S5
8
Q
Vertebral Level =
A
Refers to the bony structures of the spine (C1–C7, T1–T12, L1–L5, S1–S5, Co1)
What you palpate or see on X-ray/MRI
9
Q
Spinal (Cord) Level =
A
Refers to the segment of the spinal cord where spinal nerves emerge
Named by the nerve root (C1–Co1)
Often higher than the vertebra at which the nerve exits — especially for lumbar, sacral, and coccygeal segments
10
Q
thoracic cord segments lie:
A
within thoracic vertebrae but end before the lower thoracic vertebrae
11
Q
Lumbar and sacral cord segments are located:
A
higher up than their corresponding vertebrae — clustered around T10–L1 vertebral levels
12
Q
conus medullaris (end of the spinal cord) is around:
A
L1–L2 vertebral level
13
Q
An injury at T12 vertebral level might affect:
A
lumbar or sacral spinal cord segments
14
Q
A herniated disc at L4–L5 vertebral level can compress:
A
L5 spinal nerve (because roots travel down before exiting)
15
Q
Ascending Tracts:
A
Dorsal Columns (deep touch, proprioception, vibration)
Anterolateral System (ALS)
> lateral STT (pain and temp)
> ventral STT (light touch)
16
Q
Descending Tracts:
A
Corticospinal tracts
> lateral (motor)
> ventral (motor)
17
Q
DCML functions:
A
SENSORY
poor val got GBS 2x KF
Proprioception
vibration
graphesthesia
barognosis
stereognosis
2-pt discrimination
kinesthesia
fine touch
18
Q
Proprioception
A
tests: Joint position sense
Move joint (toe/finger) slightly up/down with eyes closed; patient identifies direction
19
Q
Vibration
A
tests: Vibration sense
Use tuning fork on bony prominences (e.g., medial malleolus, wrist)
20
Q
Graphesthesia
A
tests: Cortical interpretation
Draw a number/letter on palm with patient’s eyes closed; they identify it
21
Q
Barognosis
A
tests: Weight discrimination
Give objects of different weight in each hand; patient tells which is heavier
22
Q
Stereognosis
A
tests: Object recognition
Place object (key, coin) in hand; patient identifies it without looking
23
Q
2-Point Discrimination
A
tests: Tactile spatial resolution
Use calipers or paperclip; patient reports if they feel 1 or 2 points on skin
24
Q
Spinal Pathway: Dorsal Column–Medial Lemniscus
lesions:
A
Posterior spinal cord (e.g., tabes dorsalis, B12 deficiency) → loss of these sensations
Parietal lobe → impaired interpretation despite intact sensation (cortical sensory loss)
25
ALS: Spinothalamic tracts (STT)
Functions:
SENSORY
* Anterior STT: Crude touch
* Lateral STT: Pain and temperature
26
Corticospinal tract
Functions:
MOTOR
Movements
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CRUDE TOUCH vs FINE TOUCH
Crude Touch = Non-discriminative touch — you can tell something is touching you, but not where or what it is
ex) Light brushing, vague touch
- Anterior Spinothalamic Tract (ASTT)
Fine Touch = Discriminative touch — you can localize and describe the touch
ex) 2-point discrimination, stereognosis
- Dorsal Column-Medial Lemniscus (DCML)
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Fine touch pathway:
Ascends ipsilaterally in spinal cord → crosses in medulla → thalamus → sensory cortex
29
Crude touch pathway:
Crosses in spinal cord near entry → ascends contralaterally
30
A patient presents with the inability to sense and name the alphabets
that the physical therapist is drawing on the patient’s hand. Which of
the following is MOST LIKELY to be affected along with this
presentation?
A. Inability to sense temperature difference
B. Inability to identify objects with eyes closed
C. Inability to sense pin prick with eyes closed
D. Inability to sense crude touch
B. Inability to identify objects with eyes closed
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SCI Differential Diagnosis:
posterior cord syndrome
anterior cord syndrome
brown sequard syndrome
central cord syndrome
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Posterior Cord Syndrome:
* Tract: DCML
* Functions lost: Vibration, proprioception, 2 pt discrimination
Preserved motor, pain, temp
very rare
Cause: Iatrogenic = by medical intervention (error)
33
Posterior Cord Syndrome: common causes
MS
Posterior tumors compressing the cord
Trauma
B12 deficiency
posterior surgical approach to spine - error
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Posterior Cord Syndrome: Clinical Presentation
Bilateral loss of vibration, proprioception, and fine touch below the lesion
Patient may appear ataxic, need to watch their feet to walk
Positive Romberg sign (balance worsens with eyes closed)
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Anterior Cord Syndrome:
* Tract: STT and Corticospinal
* Function lost: (ALS) Pain/Temp and (CST) Motor
Preserved dorsal column (light touch, proprioception)
Cause: Hyperflexion injury
36
Anterior Cord Syndrome: common causes
Flexion injury, ASA infarct
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Anterior Cord Syndrome: Clinical Presentation
Patient can't move or feel pain/temp below the lesion
Still knows where their body is in space and can feel vibration
Prognosis is often poor for functional motor recovery
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Brown Sequard Syndrome:
Hemi-section of spinal cord
Cause: penetrating trauma = Stab wound or gun shot injury
loss of pain, temperature, and light touch on opposite side
loss of motor function, and vibration, position, and deep touch sensation on same side as the cord damage
Might see spasticity or hyperreflexia ipsilaterally from UMN involvement
39
Brown Sequard Syndrome: Ipsilateral
Symptoms
DCML sensory function loss below
injury level = Loss of vibration, position sense, & fine touch
Corticospinal tract (motor) function loss below injury level = Motor weakness or paralysis below level
40
Brown Sequard Syndrome: Contralateral Symptoms
Loss of pain and temp below and at
the level of injury
STT - lateral
41
Central Cord Syndrome:
Cause: Hyperextension injury, often from a fall or trauma in individuals with narrowed cervical spinal canal
Greater weakness in upper limbs than lower limbs
Variable sensory loss, sacral sparing
Central gray matter, CSTs (cervical UE fibers)
42
Central Cord Syndrome: small lesion
Weakness mostly in UEs
Pain & temp loss in cape-like distribution
UE motor fibers are medially located in corticospinal tract; pain/temp loss from crossing STT fibers near central canal
43
Central Cord Syndrome: large lesion
Motor loss in UEs and LEs
sensory loss (variable) | More widespread damage including lateral CST and dorsal columns if lesion expands |
44
Central Cord Syndrome: Classic Clinical Presentation
UE weakness > LE weakness
May retain bowel/bladder function (depends on severity)
"Shawl" or “cape-like” sensory loss pattern (especially in small lesions)
Most common in cervical region
45
Central Cord Syndrome: Pathways Affected
Anterior horn → LMN weakness at level of lesion
Crossing spinothalamic fibers → loss of pain/temp bilaterally at that level
Corticospinal tract → UE motor loss > LE (due to medial-to-lateral somatotopy)
Dorsal columns = usually spared early but affected in larger lesions
46
A patient with a history of a stab wound, disrupting the left side of the spinal cord, is being evaluated by the therapist. Which of the following is the MOST LIKELY presentation for this patient?
A. Symptoms of damage to corticospinal tract and spinothalamic tract seen on the right side of the body and symptoms of damage to the dorsal column medial lemniscus seen on the left side of the body
B. Symptoms of damage to corticospinal tract and dorsal column medial lemniscus seen on the right side of the body and symptoms of damage to the spinothalamic tract seen on the left side of the body
C. Symptoms of damage to corticospinal tract and spinothalamic tract seen on the left side of the body and symptoms of damage to the dorsal column medial lemniscus seen on the right side of the body
D. Symptoms of damage to corticospinal tract and dorsal column medial lemniscus seen on the left side of thebody and symptoms of damage to the spinothalamic tract seen on the right side of the body
D. Symptoms of damage to corticospinal tract and dorsal column medial lemniscus seen on the left side of thebody and symptoms of damage to the spinothalamic tract seen on the right side of the body
47
Why is lumbar puncture done at L3-L4 level?
Because the spinal cord ends at approximately the L1–L2 vertebral level in adults
Avoid damaging the spinal cord
Access the subarachnoid space safely (where the CSF is located)
48
At what VERTEBRAL level does the spinal cord end?
L1–L2 vertebrae
end point is called the conus medullaris
49
injuries above L1–L2 can cause:
UMN signs.
50
Injuries below L1–L2 (cauda equina) show:
LMN signs.
51
Conus Medullaris vs Cauda Equina
location:
Conus Medullaris: Bilateral and
symmetrical in perineum and thighs
Cauda Equina: Unilateral and asymmetrical in perineum, thighs, leg, back
52
Conus Medullaris vs Cauda Equina
sensory:
Conus Medullaris: Saddle
distribution, Bilateral, symmetric
Cauda Equina: Saddle distribution
unilateral, asymmetric
53
Conus Medullaris vs Cauda Equina
motor:
Conus Medullaris: Symmetric
Cauda Equina: Asymmetric
54
Conus Medullaris vs Cauda Equina
type:
Conus Medullaris: UMN + LMN
Cauda Equina: LMN
55
Complete injury:
No sensory or motor function in the lowest sacral segments
(S4 and S5)
56
Incomplete injury:
Motor and/or sensory function below the neurological level including sensory and/or motor function at S4 and S5
57
segmental level: C5
muscle group:
Elbow flexors
57
Incomplete: syndromes
* Anterior cord syndrome
* Posterior cord syndrome
* Brown Sequard syndrome
* Central cord syndrome
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segmental level: C6
muscle group:
Wrist extensors
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segmental level: C7
muscle group:
Elbow extensors
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segmental level: C8
muscle group:
Finger flexors
61
segmental level: T1
muscle group:
Fifth finger abductors
62
segmental level: L2
muscle group:
Hip flexors
63
segmental level: L3
muscle group:
Knee extensors
64
segmental level: L4
muscle group:
Ankle dorsiflexors
65
segmental level: L5
muscle group:
Long toe extensors
66
segmental level: S1
muscle group:
Ankle plantarflexors
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Spinal Cord Injury Level: sensory level
The most caudal segment of the spinal cord with normal sensory function on BOTH sides of the body.
* Lowest level where sensation is 2/2
68
Spinal Cord Injury Level: motor level
The most caudal segment of the spinal cord with normal motor function on BOTH sides of the body.
* Lowest key muscle that has a grade of at least 3 (fair), providing the key
muscles represented by segments above that level are judged to be 5 (normal)
69
Spinal Cord Injury Level: Neurological/Functional Level
The most caudal segment of the spinal cord with normal sensory and motor function on BOTH sides of the body.
70
Motor Level
Easy Steps:
1. Lowest Level at which strength is at least 3/5
2. All levels above being 5/5
Scored for each side, overall score is last normal for both
71
Sensory Level
Easy Steps:
1. Lowest level where you have “2’s”
2. All above levels being “2’s”
Defined as the level where sensory
function is normal on both sides of the
body.
72
Neurological Level
Easy steps:
1. Find Motor and Sensory level
2. Pick the higher one
CAUDAL most level with NORMAL
sensory and motor function on BOTH sides of the body
73
Sensory: C7
Motor: C8
Neurological:
C7
74
Sensory: C8
Motor: C7
Neurological:
C7
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ASIA A
Complete
No motor or sensory function at S4–S5
76
ASIA B
Incomplete
Sensory but no motor function present below Neurological Level of Injury (NLI) and S4-S5
No motor function more than 3 levels below injury
77
ASIA C
Incomplete
LESS than HALF of key muscle functions below the single NLI have a muscle grade ≥3
Motor function preserved more than 3 levels below injury
78
ASIA D
Incomplete
AT LEAST HALF (half or more) of key muscle functions below the single NLI having a muscle grade ≥3
79
ASIA E
Normal
Motor and sensory function is NORMAL
80
A physical therapist is treating a patient, who has been classified as ASIA D. Which of the following is TRUE about this patient?
A. Motor function is preserved with only 1/3 of the key muscles below the
neurological level of injury have a muscle grade of greater than 3
B. Motor function is preserved with 1/2 of the key muscles below the Neurological level of injury have a muscle grade of less than 3
C. Motor function is preserved with less than 1/2 of the key muscles below the
neurological level of injury have a muscle grade of more than 3
D. Motor function is preserved with more than 1/2 of the key muscles below the neurological level of injury have a muscle grade of less than 3
B. Motor function is preserved with 1/2 of the key muscles below the Neurological level of injury have a muscle grade of less than 3
81
Cardiac Complications with SCI:
Orthostatic Hypotension, Autonomic dysreflexia
82
Pulmonary Complications with SCI:
Respiratory Dysfunction
83
GU Complications with SCI:
Urinary and bowel retention +/- incontinence
84
Integumentary Complications with SCI:
Pressure Ulcers
85
MSK Complications with SCI:
Contracture, weakness, tone
86
Cardiovascular System:
Autonomic Dysreflexia/Hyperreflexia
At or above T6
* Noxious stimuli below level of lesion
* Rise in systolic blood pressure of 20 to 30 mmHg is diagnostic of an episode of autonomic dysreflexia
* More common in chronic stage (3-6 months after injury); can be seen in acute too
* More common with complete SCI
87
Causes of Autonomic Dysreflexia and
Signs/Symptoms
Bladder/Bowel irritation: Increase BP (Systolic BP rise 20-30 mmHg)
Painful stimulus BELOW level of lesion: Decrease HR
GI irritation: Severe headache, anxiety
Sexual activity: Constricted pupils, blurred vision
Labor: Flushing, piloerection above level of lesion
Fracture below level of lesion: Dry, pale skin below lesion
Increased spasticity
88
Autonomic Dysreflexia Intervention
* SIT UP and LOWER LEGS
* Remove painful stimuli:
̶> Loosen clothing, abdominal binder
̶
> CHECK BLADDER distension: Unclamp catheter, drain it
* Monitor vitals throughout: If still no change, medical/nursing assistance > meds to lower BP (Nifedipine, nitrates, and captopril)
89
Which of the following is MOST
LIKELY expected to be present in
this case - C5 SCI?
A. Loss of ability to raise eyebrows
and chew food.
B. Positive Babinski and clonus
C. Flaccidity of lower extremity
muscle affecting gait
D. Loss of ability to move eyes in
vertical direction
B. Positive Babinski and clonus
C5 SCI = UMN
90
Loss of ability to raise eyebrows
and chew food =
CN VII
91
Loss of ability to move eyes in
vertical direction =
CN III
92
During the treatment session today,
the physical therapist had to stop the
intervention because the patient
developed blurriness in the vision and
reported a severe headache. The
physical therapist suspects the
patient to have autonomic
dysreflexia. What other signs and
symptoms are MOST LIKELY to be
present in that case?
A. Bradycardia and hypertension
B. Hypotension and bradycardia
C. Tachycardia and hypertension
D. Hypotension and tachycardia
A. Bradycardia and hypertension
