Spinal Cord Injury

Question 1

clinical effects of complete spinal cord injury

Answer 1

all voluntary movement and sensory gone

reflex function in all segments are suspeded

Question 2

definition of level of injury

Answer 2

most caudal segment with normal sensation and muscle strength of 3/5 or better with the level immediately above 5/5

Question 3

complete vs incomplete lesion

Answer 3

complete: no preservation of any motor or sensory function
incomplete: any residual motor or sensory function more than 3 segments below the level of injury

Question 4

signs of incomplete cord injury

Answer 4

any sensation or voluntary movement in LE
sacral sparing (anus sensation, perineum, voluntary anal contraction)
preservation of sacral reflexes not counted

Question 5

what is spinal shock

Answer 5

profound loss of all spinal reflexes below level of injury + complete paralysis and anesthesia

NOT THE SAME AS COMPLETE CORD INJURY

Question 6

presentation of spinal shock

Answer 6

flaccid paralysis
areflexia
hypotonic paralysis of bowel and bladder
hypotension, anhidrosis, flushed warm peripheral skin
hypotension without compensatory tachy (if high cervical lesion)

Question 7

triad of neurogenic shock

Answer 7

hypotension
bradycardia
hypothermia

more common in injuries above t6 due to secondary disruption of sympathetic outflow from t1-l2

Question 8

t/f less complete lesions and slow developing lesions result in little to no spinal shock

Answer 8

true

Question 9

mechanisms of spinal cord injury

Answer 9

vertical compression
hyperflexion
rotational
hyperextension

Question 10

characteristics of vertical compression

Answer 10

creates axial node on vertebra –> vertebral body is compressed –> burst fracture

usually in lumbar

Question 11

characteristics of hyperreflexion injury

Answer 11

causes wedge fractures and stretched interspinous ligaments

Question 12

characteristics of rotational injuries

Answer 12

shearing injury that causes fracture

results in tearing of posterior ligamentous structures and displacement of vertebrae

Question 13

characteristics of hyperextension injury

Answer 13

causes a disruption in the anterior longitudinal ligament or buckling of ligamentum flavum into spinal canal

can rupture intervertebral discs

Question 14

asia impairment scale

Answer 14

table 4

Question 15

pathology in acute paraplegia syndrome

Answer 15

squeezing or shearing in spinal cord –> destruction of gray and white matter + hemorrhage –> traumatic necrosis

healing –> gliotic focus or cavitation + hemosiderin and iron
in months/years: progressive cavitation happens (traumatic syringomyelia or fluid build up) –> delayed central or incomplete transverse cord syndrome

Question 16

t/f in most traumatic lesions, the lateral parts suffer greater injury

Answer 16

false, the central parts

Question 17

features of cord injury in c1-c3

Answer 17

vasomotor and respiratory collapse = ventilator support

Question 18

features of cord injury in c4-c5

Answer 18

quadriplegia/tetraplegia with preserved respiratory function

complete paralysis below the neck

Question 19

features of cord injury in c5-c6

Answer 19

sparing of shoulder muscles with partial paralysis of arm and hands
loss of biceps and brachioradialis reflexes
paralysis of lower body

Question 20

features of cord injury in c7 and c8

Answer 20

c7: biceps sparing, loss of triceps reflex
c8: triceps sparing, paralyzed fingers and wrist flexion

Question 21

high vs low cervical cord injury

Answer 21

table 6

Question 22

features of t6 injury

Answer 22

paraplegia (xiphoid process)

Question 23

features of t9 injury

Answer 23

paralysis of lower abdominal muscles
loss of superficial abdominal reflexes
(+) beevor sign

Question 24

high vs low thoracic cord injury

Answer 24

high: spares UE, impaired breathing, ileus, paraplegia
low: spares abdominal muscles, normal breathing,

Question 25

lumbar cord injury (l1)

Answer 25

paraplegia

Question 26

incomplete injuries of spinal cord

Answer 26

central cord syndrome anterior spinal cord syndrome (anterior 2/3) posterior spinal cord syndrome (posterior column) brown sequard syndrome (hemisection)

Question 27

most common type of incomplete spinal cord injury

Answer 27

central cord syndrome - symmetrical incomplete quadriparesis, disproportionately affecting ue

Question 28

tracts affected in central cord syndrome

Answer 28

cervical corticospinal | cervical lateral spinothalamic

Question 29

pathophysio of ccs

Answer 29

fall forward and hit chin = hyperextension usually with preexisting narrowing of spinal canal spinal cord rubs against disc osteophyte = anterior compression inward buckling of ligamentum flavum = posterior compression

Question 30

clinical presentation of ccs

Answer 30

loss of pain and temperature in the distribution level of the injury expansion of lesion = weakness at level of sensory loss

Question 31

syringomyelia in ccs

Answer 31

fluid filled cavitation in the cord - loss of pain and temp sensation (cape-like sensory loss) - suspended sensory loss - weakness of muscles in arms with atrophy and hyporeflexia - later: cst involvement with brisk reflexes in legs, spasticity and weakness

Question 32

etiology of syringomyelia in ccs

Answer 32

trauma | chiari type 1 malformation

Question 33

clinical presentation of syringomyelia

Answer 33

central cord syndrome (arms weaker than legs) dissociated sensory loss areflexic weakness in ue

Question 34

management of syringomyelia

Answer 34

syringo-subarachnoid shut

Question 35

another type of lesion that can have similar presentation with ccs

Answer 35

intramedullary tumor

Question 36

clinical presentation of anterior spinal cord syndrome

Answer 36

bilateral muscle weakness (cst) bilateral loss of pain and temp sensation (stt) urinary incontinence (descending autonomic tracts) posterior column sparing

Question 37

etiology of ascs

Answer 37

anterior spinal artery infarction 2/3 (thromboembolism, trauma, vertebral burst fracture) intervertebral disc herniation radiation myelopathy spinal metastasis (fracture or sc compression) cervical spine injury w/ wedge and burst fractures (bone compressing)

Question 38

progression of symptoms in ascs

Answer 38

``` back pain numbness of limbs difficulty walking urinary urgency paralysis ```

Question 39

least favorable prognosis in all of syndromes

Answer 39

ascs preservation of some sensory or motor function below the level of injury are good prognostic factors

Question 40

clinical presentation of posterior spinal cord syndrome

Answer 40

loss of proprioception and vibration sense no weakness bladder dysfunction

Question 41

clinical presentation of brown sequard syndrome

Answer 41

ipsilateral: weakness, lmn symptoms at level, umn symptoms below, loss of proprioception, vibrationi, light touch, and tactile sense contralateral findings: loss of pain and temperature sensation

Question 42

etiology of brown sequard syndrome

Answer 42

knife or bullet ms tumor

Question 43

t/f cauda equina syndrome is part of incomplete cord injuries

Answer 43

false

Question 44

clinical presentation of cauda equina syndrome

Answer 44

radicular pain in sciatic distribution that worsens with coughing or sneezing severe radicular sensory deficits in legs and saddle area lmn deficit: flaccid paresis of le with areflexia, urinary and fecal incontinence, impaired sex

Question 45

clincial presentation of conus syndrome

Answer 45

``` detrusor areflexia with urinary retention and overflow incontinence fecal incontinence impotence saddle anesthesia loss of anal reflex ```

Question 46

management for conus syndrome

Answer 46

open surgery to remove disk that comes out

Question 47

clinical presentation of poliomyelitis

Answer 47

lower motor neuron weakness (invasion of anterior horn cells) flaccid paralysis atrophy areflexia