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Clinical Med (Year 2) > Spinal Cord Injury (Exam 2) > Flashcards

Spinal Cord Injury (Exam 2) Flashcards

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1
Q

What is a traumatic SCI and what is it caused by?

A
  • Irreversible damage to the spinal cord
  • Caused by: mechanical force
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2
Q

Traumatic SCI: MOI
What factors can affect vertebral injury?

A
  • Direction of force applied to system
  • Position of person’s head at time of injury
  • Magnitude, rate of application and duration of injuring force
  • Point of application
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3
Q

What are the most common damaging forces in the C-spine?

A
  • Flexion
  • Vertical loading
  • extension
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4
Q

In hyper flexion injury anterior structures are (BLANK) and posterior structures are (BLANK)

A
  • Compression anterior
  • Posterior are distracted
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5
Q

What areas of the C-spine are most commonly injured during hyper -flexion injury?

A

C5-C7

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6
Q

What type of cord syndrome can be caused because of a hyper-flexion?

A

anterior cord syndrome

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7
Q

(Cervical) Flexion with rotation mechanism of SCI is often seen with what?

A

Lateral flexion

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8
Q

What does flexion with rotation MOI often result in?

A
  • Dislocation and locking of a single facet joint
  • Possible fracture of lamina or pedicle
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9
Q

What neurological damage can occur in a flexion with rotation MOI?

A
  • Brown Sequard
  • Nerve roots
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10
Q

A vertical compression/axial loading MOI occurs with what type of force?

A

High velocity blow to top of head

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11
Q

Vertical compression/axial loading MOI often have what injury associated with them?

A
  • Often have burst fracture
  • Fracture fragments may migrate posteriorly and enter spinal canal and lodge in cord
  • Rupture of disc
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12
Q

Where does vertical compression/axial loading most often occur in the C-spine?

A

C4-C5 resulting in complete quadriplegia

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13
Q

What force cause can cause a hyperextension injury to the cervical spine?

A

Strong posterior force
- Rear end collision
- Fall & hit chin or forehead

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14
Q

With hyperextension of cervical spine structure anterior are (BLANK) and structures posterior are (BLANK)

A
  • Anterior is distracted
  • Posterior is compressed
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15
Q

What cord lesion can hyperextension cause?

A

Central cord lesion

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16
Q

Why is the thoracic spine more stable than the cervical spine?

A

Rib cage T1-T10

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17
Q

What junction is most commonly injured?

A

T12-L1

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18
Q

Flexion MOI of the thoracic spine result in what injuries?

A
  • Wedge fracture
  • Posterior ligamentous complex may be damaged due to distractive forces (severe)
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19
Q

Vertebral compression MOI of the thoracic spine results in what injuries?

A
  • Burst fractures result in bone fragments into spinal canal
  • Penetrating injury
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20
Q

What force causes a flexion - rotation injury to the lumbar spine?

A

Posterior to anterior force directed at rotated vertebral column

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21
Q

What injuries are typically caused by flexion-rotation injuries to the lumbar spine?

A
  • Typically causes fracture & dislocation
  • Posterior ligamentous complex is ruptured accompanied by vertebral body fractures
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22
Q

Flexion-distraction (Chance Fracture) often results from what?

A

Use of lap belt without shoulder restraint

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23
Q

How does lap belt cause a flexion - distraction (Chance Fracture)?

A
  • Lap belt becomes a pivot point (fulcrum)
  • Flexion distraction force from that point
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24
Q

In a flexion-distraction (Chance Fracture) how are fractures and ligamentous tears oriented?
- Where is the injury?
- What other injuries may occur?

A
  • Oriented: horizontally
  • Injury in thoraco-lumbar junction
  • May have severe internal injuries
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25
In traumatic SCI often secondary microvascular, biochemical, and cellular processes happen what can this result in?
- Apoptosis, Edema, Inflammation - Release of glutamate - Imbalance of calcium levels
26
What are the 6 etiologies of non traumatic SCI?
- Vascular damage (hemorrhage, ischemia, AVM) - Space occupying lesion (neoplasm, syrinx, abscess) - Infection (transverse myelitis) - Primary damage (MS, ALS) - Compression (degenerative joint disease) - Myelomeningocele (most serious form of Spina Bifida)
27
What is tetraplegia? What area of the spine is injured to result in tetraplegia?
- Tetraplegia: involvement of all 4 extremities and the trunk - C1-C8
28
What is paraplegia? What area of the spine is inured to result in paraplegia?
- Paraplegia: Involvement of the legs and part of the trunk - T1-S5
29
For an injury to be classified as incomplete what needs to be spared?
Some sparing of sensory and/or motor function
30
Where is the highest SCI injury frequency at?
C5-C7 and T12-L2
31
T/F: SCI result in a lot of financial impact
True
32
What is the most common spinal cord injury diagnosis?
Incomplete tetra
33
What is the ABC of the initial management of SCI?
Airway Breathing Circulation
34
What is the initial management of SCI?
- Management of life threatening injuries - Spinal stabilization/immobilization (no A/PROM, backboard, C- collar) - Transportation to trauma center
35
After arriving at the trauma center after SCI what is done?
- Ensure optimal ventilation & circulation - Diagnosis of SCI (physical, neurological & imaging)
36
What are the types of imaging used to diagnosis SCI?
- Radiographs - CT - Myelography - MRI
37
What radiographs will be used to diagnose SCI?
- C -Spine lateral radiographs (rapid and effective w/ 85% accuracy) - Open mouth & AP radiographs (almost 100% accuracy)
38
What information does a CT give when diagnosing SCI?
Valuable information on impingement on neuronal canal as well as bony limits of spinal cord
39
T/F: Myelography is rarely used alone, may be used in conjunction with CT
True
40
What information does a MRI give when diagnosing SCI?
- Appropriate imaging technique for visualizing the necessary tissue - However, in acute SCI other equipment in the surrounding area may limit its use
41
Once the patent is in the ICU they receive close monitoring of what systems?
- Respiratory Status (may require ventilator) - Organ function - Cardiovascular status (avoid hypotension & hypoxia) - Bowel/bladder management (catheter insert) - Integumentary integrity
42
T/F: There is not evidence to support the use of pharmacologic agents to improve outcomes
True
43
What is the intent of high dose steroids?
- Reduce edema to increase motor recovery New research shows does not lead to improved functional outcomes & can have negative effects
44
What is the purpose of acute pharmacological management of SCI?
- Aimed at managing neurologic sequelae & secondary complication (pain, heartburn/ulcers, infection, constipation, preventive)
45
What is the intent of local & systemic hypothermia?
- Reduce secondary damage & neuroprotection - Body temp is systematically cooled to minimize secondary ischemia. cell death, oxidative stress, inflammation & edema
46
T/F: Further research is needed on the effectiveness and dosage of local & systemic hypothermia
True
47
When is an open reduction surgery indicated?
- Unstable fracture site - Cord compression - Malalignment - Deteriorating neuro status
48
When is open reduction surgery recommended to take place?
Early: within 24 hours
49
What are some non-surgical intervention options?
- Traction devices (cervical subluxation, fracture/dislocation) - Immobilization (potentially positions in a rotating bed)
50
When is immobilization indicated?
Whether closed or open reduction
51
When is Halo immobilization indicated?
- Cervical fractures - Most effective at decreasing cervical rotation
52
What immobilization tactics are used in acute medical management of SCI?
- Halo - Spinal orthosis - Recumbent positioning
53
What are some factors to keep in mind when your patient is immobilized?
- Aware of wearing schedules - Monitor skin integrity (pads should be changed routinely and be aware of pressure areas) - impact on plan of care
54
Traumatic SCI before age 15 is relatively rare, but when it does occur what are some MOI?
- MVA - Sport related injuries - Falls - Abuse
55
In pediatric SCI injury to what level is most common?
Cervical level injuries
56
What are some non-traumatic causes of pediatric SCI?
- Myelomeningocele/ Spina Bifida - Tumor or Abscess - Transverse Myelitis - AV Malformation - Compressive myelopathies - SC infarction due to thromboembolic disorders - Developmental abnormalities of the cervical vertebrae
57
What are some back board consideration for stabilization of pediatric SCI?
- Used with infants and toddlers to allow for neutral alignment of c-spine - Occiput cut-out - Elevating torso pad
58
What does SCIWORA stand for?
Spinal Cord injury without Radiographic Abnormality
59
T/F: SCIWORA is common in pediatrics
True
60
What is the most common sign of SCIWORA?
- Signs of acute trauma but no findings on CT or X-Ray - Midline Cervical tenderness most common sign
61
What are some treatments for Pediatric SCI?
- Similar treatment of anterior decompression & spinal stabilization surgeries - Halo for younger children
62
Who has a slightly better prognosis & neurologic recovery following an SCI?
Pediatric > Adults Incomplete > complete
63
After a Pediatric SCI the individual has a high likelihood of developing (BLANK) and what is the treatment?
Scoliosis - 23% to 97% likelihood when SCI occurs before teenage growth spurt (<12y/o) -Treatment: Bracing or Surgical intervention
64
In pediatrics depending on the SCI location muscle imbalance can cause what?
- Abnormal growth & contractures
65
When SCI occurs at a young age what are some concerns involving bowel & bladder?
smaller capacity to hold urine and increased risk of renal disease
66
T/F: An implication of pediatric SCI is osteoporosis with high incidence of fracture
True
67
T/F: Multidisciplinary Rehab and Family Centered Care is important throughout life after pediatric SCI
True
68
What is transient reflex depression after spinal shock?
Abrupt withdrawal of connections between cortex and spinal cord
69
Spinal shock is characterized by what?
- Areflexia (loss of reflexes--> bulbocavernosus, cremasteric, babinski) - Impaired autonomic regulation (hypotension, no sweating, no pilo-erection)
70
How long does spinal shock last?
- Total areflexia = 24 hours - Gradual return of reflexes in 1-3 days - Increasing hyperreflexia up to 4 weeks
71
SCI Classification: Basics SCI A: - Injury Type? - Description?
Injury Type: Complete Description: Absent
72
SCI Classification: Basics SCI B: - Injury Type? - Description?
Injury Type: Sensory Incomplete Description: Absent Motor, Have some sensation
73
SCI Classification: Basics SCI C: - Injury Type? - Description?
Injury Type: Motor Incomplete Description: < 50% mm have ≥ 3/5 below NLI, Have sensation
74
SCI Classification: Basics SCI D: - Injury Type? - Description?
Injury Type: Motor Incomplete Description: ≥ 50% mm have ≥ 3/5 below NLI, have sensation
75
What is an Anterior Cord Syndrome caused by and what is injured?
- Caused By: flexion injury to the cervical spinal cord - Damage: Anterior cord damage (fx, dislocation or cervical disc protrusion) & Anterior spinal artery
76
What is lost in an Anterior Cord Syndrome?
- Motor Function (CST) - Pain/temp (ALS/ Spinothalamic Tract)
77
What is preserved in an Anterior Cord Syndrome?
Light touch, proprioception, vibration (DCML)
78
T/F: With an Anterior Cord Syndrome longer rehabilitation is usually required
True
79
What is the most common SCI syndrome?
Central Cord Syndrome
80
What is central cord syndrome caused by?
- Hyperextension injury of cervical spine - Congenital/degenerative narrowing of spinal canal leading to hemorrhage and edema in central cord
81
What is the clinical presentation of central cord syndrome?
- UE > LE involvement - Motor > Sensory Impairments - Sacral Tract may be preserved
82
Patients with a Central Cord Syndrome typically recover ability to (BLANK) but severe limitations in (BLANK)
Recover ability to ambulate Severe limitation in ADLs
83
Brown-Sequard Cord Syndrome is caused by what?
- Hemi section of the spinal cord injured - Gunshot or stab wound
84
What is the clinical presentation of Brown-Sequard Cord Syndrome?
- Ipsilateral: DCML & CST (loss of proprioception/Vibration/Motor function - Contralateral: ALS (Loss of pain & temp) (Potentially several levels lower than the LOI)
85
What is the least common clinical cord syndrome?
Posterior Cord Syndrome
86
What does the posterior cord syndrome affect and what is lost?
-Affect: Posterior Columns (DCML) - Loss: Proprioception & vibration below level of injury
87
What is preserved with posterior cord syndrome?
Muscle strength, pain & temperature sensation
88
What are some MOI of posterior cord syndrome?
- Neck hyperextension - posterior spinal artery occlusion - tumors - disc compression
89
Describe Conus Medullaris Syndrome
- L1 lesion - UMN & LMN signs
90
What is a Cauda Equina injury?
- LMN lesion (incomplete more common)
91
What is the clinical presentation of Cauda Equina Injury?
- Bowel/bladder impacted (areflexic) - Saddle anesthesia - LE paresis (L2, L3, L4 vs L5, S1, S2 injury)
92
Why is the potential for regeneration after Cauda Equina injuries poor?
- Large distance between lesion & innervation site - Axonal regeneration may not occur along original distribution - Glial - collagen scarring block regeneration - End organ/mm may no longer be functioning - Rate of regeneration slows & finally stops after 1 year
93
What is the impact of SCI across the ICF?
Impairments
94
What are the primary implication of SCI impairments?
- Motor & Sensory Impairments - Autonomic Dysfunction - Cardiovascular Impairments - Abnormal Tone - Pulmonary/Respiratory Impairment - Bowel/Bladder/Sexual Dysfunction - Pain
95
What are some secondary impairments of SCI?
- Pressure ulcers - DVT - Contractures - Osteoporosis - Psychosocial Impact - Heterotrophic Ossification
96
What determines the motor & sensory impairments and what are they related to?
- Determined by: International Standards for Neurological Classification of Spinal Cord Injury (ISNSCI) - Related to: Level of injury (deficits below), Completeness of injury, clinical syndrome may be present
97
After spinal shock resolves below level of injury what occurs?
spastic hypertonia
98
Spastic hypertonia occurs after what? And what does it include?
- After UMN injury (more common in c/s injuries) - Includes - Spasticity - Hyperactive reflexes - Clonus - High muscle tone - mm spasms
99
Spastic hypertonia has a gradual increase up to (BLANK) months and plateau at (BLANK)
- Increase up to 6 months - Plateau at 1 year
100
What is spastic hypertonia triggered by?
- UTI - Pressure ulcers - Stress - Temperature - Pain - Positional changes - Tight clothing
101
What are some functional implications of spastic hypertonia?
Either can be helpful or hinder
102
In relation to Autonomic Dysfunction- Cardiovascular Impairments: What are the signals to the heart? - Parasympathetic Output? - Sympathetic Output? - C7 Injury implications? - T10 injury implications?
- Parasympathetic Output: Vagus N - Sympathetic Output: T1-L2 (Specific concerns are above T6) - C7 Injury implications: Full parasympathetic & no sympathetic - T10 injury implications: Both sympathetic & parasympathetic
103
In regards to autonomic dysfunction, what is spinal shock?
- Altered physiologic state immediately after a SCI, which presents as loss of spinal cord function caudal to the level of the injury, with flaccid paralysis, anesthesia, absent bowl & bladder control, and temporary loss of reflex activity - Over once bulbcavernousus reflex return (pudendal nerve)
104
In regards to autonomic dysfunction, what is neurogenic shock?
- Refers to the hemodynamic instability seen in these patients with hypotension, bradycardia, and hypothermia (secondary to sympathetic- parasympathetic dysfunction/imbalance). - Occurs in injuries above T6 (>50% loss of sympathetic innervation)
105
In regards to autonomic dysfunction (cardiovascular impairments) the impairment neurogenic shock results in (initial weeks in above T6 injury)?
- SBP < 100mmHG - HR < 80 bpm - Parasympathetic unopposed
106
In regards to autonomic dysfunction (cardiovascular impairments) the impairment bradycardia initially results in?
100% in AIS A & B Cervical injury
107
In regards to autonomic dysfunction (cardiovascular impairments) the impairment hypotension, orthostatic too, results in?
Dilation of peripheral vasculature below LOI
108
In regards to autonomic dysfunction (cardiovascular impairments) the impairment autonomic dysreflexia is?
Life-threatening
109
Orthostatic hypotension is caused by what?
Impaired sympathetic output to the heart, unopposed parasympathetic input --> Bradycardia & Peripheral dilation
110
Orthostatic hypotension causes: - (BLANK) muscle activation - (BLANK) time in bed - Beware coming to (BLANK)
- Decrease muscle activation - Prolonged time in bed - Beware coming to sit or stand
111
What are some symptoms of Orthostatic hypotension?
- Light headed - Dizzy - Blurred vision - Pale
112
Autonomic Dysreflexia occurs with with injures above what level?
T6
113
What is the order of events that cause autonomic dysreflexia?
Noxious stimuli below lesion --> afferent input to SC --> overactive sympathetic activity (mass reflex response) --> increase BP --> overactive parasympathetic above
114
If autonomic dysreflexia is not addressed quickly what can it result in?
- Seizures - Cardiac arrest - SAH - Stroke - Death
115
What are some causes of Autonomic Dysreflexia?
- Bowel bladder distention/irritation - Painful stimuli - Sexual activity - Labor - Stretching a patient too far - Fracture - E swim below the level
116
What are some signs/symptoms of autonomic dysreflexia?
- HTN - Bradycardia - Severe headache - Profuse sweating above the level - Increased spasticity - Vasodilation above level of injury (flushing-overactive parasympathetic activity) - Vasoconstriction below (overactive sympathetic activity) - Constricted pupils, blurred vision, nasal congestion, pilo-errection
117
What is the management of autonomic dysreflexia?
- Upright position - Remove source of noxious stimulus - Monitor vital - Seek medical attention if unable to resolve - Education
118
Blood pressure following SCI will like be (BLANK) especially with (BLANK) level injuries
Blood pressure following SCI will like be lower especially with higher level injuries
119
In patients with tetraplegia: - Average supine systolic BP? - Average seated systolic BP?
- Average supine systolic BP: about 110 mmHg - Average seated systolic BP: about 100 mmHg

Clinical Med (Year 2) (17 decks)

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