Traumatic Spinal Cord Injury Flashcards
(47 cards)
1
Q
most frequent causes of traumatic SCI:
A
- MVA (38%)
- Falls (30.5%)
- Acts of violence (primarily gun shot wounds; stabbings)
- Sports/Recreational injuries 9%
- Other
2
Q
Partial or complete paralysis of all 4 extremities & trunk,
including respiratory muscles, and results from lesions of cervical cord. Approx 56% of patients with SCI:
A
Tetraplegia
3
Q
Partial or complete paralysis of all or part of trunk & both LE’s and results from lesions of thoracic or lumbar cord or cauda equina. Approx 43% of patients with SCI
A
Paraplegia
4
Q
results from lesions of thoracic or lumbar cord or cauda equina
A
paraplegia
5
Q
Results from lesions of cervical cord
A
tetraplegia
6
Q
Which is currently the most frequent SCI?
Followed by?
A
- Incomplete tetraplegia
- Followed by incomplete paraplegia
- Complete paraplegia
- Complete tetraplegia
7
Q
ASIA
A
American Spinal Injury Association
- developed in 1992
- revised periodicaly
- improve accuracy and reliability of SCI examination
8
Q
What is NEUROLOGICAL LEVEL (NLI), MOTOR LEVEL, SENSORY KEVEL and SKELETAL LEVEL of injury?
A
- NL: Refers to the most caudal segment of (3 or greater) muscle function strength, provided there is normal (intact) sensory and motor function rostrally respectively
- SKL: the greatest vertebral damage is found on a radigraph.
-
ML: grade of at least 3/5 AND key muscle functions above that level are intact (grade of
5/5) - Sensory level = most caudal, intact dermatome for both pinprick and light touch sensation
9
Q
How is a complete SCI determined?
A
Determined by anal sensation and voluntary external anal sphincter contraction
10
Q
Collection of muscle fibers innervated by the motor axons within each segmental nerve root
A
MYOTOME
11
Q
preservation of some sensory or motor function below the neurological level of the lesion including sensory &/or motor function at S4 & S5
A
incomplete SCI
12
Q
(S4 and S5) no sensory or motor function in the lowest sacral segments
A
complete SCI
13
Q
complete SCI caused by?
A
- complete transection of cord
- severe compression of cord
- extensive vascular impairment
14
Q
incomplete SCI injury cause by?
A
- contusions: pressure on cord from displaced bone &/or soft tissue or from swelling within spinal canal
- partial transection of cord
15
Q
Zone of partial preservation (ZPP):
A
- Determined in complete SCI only
- Intact motor &/or sensory function below the neurological level but NO S4 & S5 motor or sensory function
- Lowest dermatome or myotome on each side with some preservation/innervation
16
Q
ASIA Impairment Scale:
A
- A = Complete: No motor or sensory function preserved in the lowest sacral segments
- B = sensory incomplete: Sensory but not motor function preserved in the lowest sacral segments
- C = motor incomplete: Motor function present below the injury but more than half key muscles are <3/5
- D = motor incomplete: Motor function present below the injury but at least half key muscles are >3/5
- E = normal: Motor and sensory function normal, only assigned if initial deficit is present
- F Some patterns of spinal cord injury have special names.
17
Q
Incomplete (SCI) Clinical Syndromes:
A
- Brown-Sequard Syndrome
- Anterior Cord syndrome
- Central Cord Syndrome
- Posterior Cord Syndrome
- Cauda Equina Injuries
18
Q
Which incomplete SCI is usually caused by stab wounds?
A
Brown-Sequard Syndrome
19
Q
What is Brown-Sequard Syndrome?
A
Hemisection of spinal cord
20
Q
Clinical features of Brown-Sequard Syndrome
A
- Ipsilateral: paralysis, loss of sensation in dermatome segment corresponding to level of lesion, abnormal reflexes, clonus, positive babinski, loss of proprioception, kinesthesia, and vibration
- Contralateral loss of pain & temperature several dermatomes below level of the lesion
21
Q
What is anterior cord syndrome?
Clinical Feautures?
A
- Flexion injuries of CS
- Damage to SC or ASA
- usually due to compression of anterior cord: fracture, dislocation, cervical disc protrusion
-
Clinical features:
- loss of motor function below level of lesion
- loss of pain & temperature below level of the lesion
22
Q
What is Central Cord Syndrome?
A
- hyperextension injuries of cervical spine
- could be congenital or degenerative narrowing of spinal canal: compressive forces lead to hemorrhage & edema
- UE’s more involved than LE’s
- varying degress of sensory loss
- motor loss more severe
- complete preservation of sacral tracts
- can ambulate
23
Q
What is posterior cord syndrome?
A
- rare
- posterior columns affected
- loss of proprioception, two-point discrimination,
graphesthesia, sterognosis below level of the lesion - wide-based steppage gait pattern typical
- preservation of motor, pain & light touch
24
Q
What is cauda equina injuries?
A
- Usually incomplete
- LMN’s lesion
- potential to regenerate, but reinnervation is not common
25
4 most common types of forces in SCI
* flexion
* compression
* hyperextension
* flexion-rotation
26
some areas of spine more susceptible to injury:
* cervical area = C5 - C7
* thoracolumbar area = T12 - L2
27
least common mechanism of injury in SCI
**Distraction:** traction force in cervical spine where head is pulled away from body
28
True or false:
shearing forces do not create SCI
false
29
Which is the most common mechanism of SCI?
**flexion**
30
what type of fx is associated with **flexion** SCI?
* *wedge fracture** of anterior vertebral body
* high % occur from C4-C7 & T12-L2*
31
what is the casue of **compression** SCI?
* vertical or axial blow to head (diving, falling objects, surfing)
* closely associated with flexion injuries
32
what is the casue of **flexion-rotation** SCI?
* posterior to anterior force directed at rotated spine ( rear end collision with passenger rotated toward driver)
33
what is the casue of **hyperextension** SCI?
* strong posterior force (rear end collision)
* falls with chin striking stationary object (often seen in elderly population)
34
Clinical Manifestations of **SCI**:
1. **Spinal shock:** Period of areflexia
2. **Motor & sensory impairments:** partial or complete bellow
3. **Autonomic Dysreflexia:** elevation of BP, medical emergency
4. **Postural Hypotension**
5. **Impaired temperature control:** autonomic dysfunction
6. **Pulmonary impairment:** tetraplegia, C1-C3 phrenic nerve
7. **Spasticity:** bellow level of lesion
8. **Bladder & bowel dysfunction**
9. **Sexual dysfunction**
10. **Secondary impairments & complications:** pressure sores, DVT
35
What is heterotopic (ectopic) ossification?
Abnormal bone growth in soft tissue below level of lesion
36
gradual increase in **spasticity** seen during \_\_\_\_\_\_\_\_\_\_
post SCI
1st 6 months
37
C1-C3 SCI may cause:
severe to mild impairment of respiratory function due to paralysis of respiratory muscles (phrenic nerve)
38
SCI autonomic (sympathetic) dysfunction can result in
* loss of internal thermoregulatory response
* **compensatory diaphoresis above level of lesion**
* no vaso dilatation/constriction is response to heat/cold
39
Incomplete SCI autonomic (sympathetic) dysfunction can result in:
**spotty areas** of localized sweating **below** level of lesion
40
Pathological autonomic reflex resulting in elevation of blood pressure
**Autonomic Dysreflexia (Hyperreflexia)**
*medical emergency*
41
what is the most common cause of **Autonomic Dysreflexia**?
bladder distention (urinary retention)
42
Most commont symptoms of **autonomic dysreflexia**:
* headache
* profuse sweating
* flushing
* hypertension (elevated BP)
## Footnote
*(slide 47 of SCI for more)*
43
Intervention in autonomic dysreflexia:
* 1st check catheter and tubing
* position pt in sitting position (lower BP)
* look for irritating stimuli: tight clothing etc.
* obtain medical assistance
44
what is the 1st indicator of spinal shock
+ bulbocavernosus reflex
45
Period of areflexia immediately following SCI, absence of all reflex activity, flaccidity & loss of sensation below level of lesion, lasts for several hours to several weeks and usually subsides within 24 hours.
Spinal shock
46
SCI postural hypotension intervention includes:
* elevation of head from the bed
* tilt table
* compressive agents
* abdominal binder
* drug therapy
47
which is the most frequent neurological category of SCI?
incomplete tetraplegia
