clinical patho week 5 material

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clinical patho week 5 material
2012-10-29 22:30:14
clinical patho

Clinical patho
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  1. spinothalamic tract
    pain and temperature
  2. fasciculus gracilis
    touch, pressure, consciouse muscle joint sense
  3. Fasciculis cuneatus
    touch, pressure, conscious muscle joint sense
  4. Dorsal spinocerebellar
  5. ventral spinocerebellar
    provides input to the cerebellum
  6. Corticospinal
    voluntary skilled movement
  7. Tectospinal
    reflex postural movement in response to visual stimuli
  8. Rubrospinal
    facilitates activity of the flexor muscles and inhibits extensors
  9. vestibulospinal
    under the influence of the ear and cerebellum in the maintenance of balance
  10. Signs an symptoms of acute shock
    • Results from abrupt withdrawal of connection between brain and spinal cord
    • Occurs immediately following an injury
    • Absence of all reflexes, flaccidity, loss of sensation and motor function below the level of the injury
    • DTR Loss
    • Last 24-48 hours (Can last days or weeks)
    • 1st indication of resolution is anal sphincter reflex
  11. Signs and symptoms of choronic shock
    • žHyper-reflexes
    • žMotor loss
    • žSensation loss
    • žAltered somatic nervous system function
    • Paralysis (Paraplegia or tetraplegia)
  12. Complete vs incomplete SCI
    • Complete Injury
    • NO sensory or motor function below the level of the lesion
    • Very Rare

    • Incomplete
    • Preservation of some motor & sensory below the level of the lesion
  13. Anterior cord syndrome
    Occurs with acute disc herniation, tumors, and when the head is forced into cervical flexion
  14. Central cord syndrome
    • More loss of movement and sensation in the arms than in the legs.
    • žOccurs with hyperextension injury, degenerative bone changes in the spine, or stenosis
    • žPreservation of bowel/bladder and sexual function
  15. Brown-sequard Syndrome
    • Hemi-section of the spinal cord
    • žTypically due to penetration injury
    • See problems on both ipsilateral and contralateral sides
  16. Posterior cord syndrome
    • Extremely Rare
    • žProprioceptive Loss is biggest limiting factor
    • Altered gait
    • Increased BOS
  17. Cauda equina injuries
    • Injury below L1 (adult), LMN injury, part of the PNS
    • žIf myelin is intact, regeneration is possible
    • žSome signs and symptoms
    • Saddle paresthesia (perineum)
    • Weakness, loss of sensation, or pain in one or both legs
    • Bowel and bladder control issues
  18. 5 factors influence ability for successful regeneration (only if myelin sheath is intact)
    • 1.Long distance to travel
    • 2.Axial regeneration can “get lost or go off path”
    • 3.As axon regenerates, scar tissue can block progress
    • 4.Tissue may no longer function if regeneration takes too long
    • 5.Because regeneration take so slow – the body gets tired of doing it and stops!
  19. Autonomic dysreflexia
    • žSome sort of noxious stimulus sends the patient into “fight or flight”:
    • Full or distended bladder
    • Bowel regulation issues
    • Sexual activity or child birth
    • Leg is pinched on leg rest
    • Awkward positioning that stimulates GTO
    • žOnce the stimulus is removed, the patient is fine
    • Lesions above T5-T7
    • žSit the patient down, but keep head elevated & Find/Remove the stimulus
  20. S/S of autonomic disrythmia


    ¡Severe and sudden HA

    • ¡Profuse sweating (above the level of
    • the lesion)

    ¡Increased spasticity

    • ¡Vasoconstriction above level of the
    • lesion and dilation below

    ¡Constricted pupils

    ¡Blurred vision
  21. S/S of postural hypotension
    • ¡Pooling of blood
    • ¡Pallor
    • ¡Dizziness
    • ¡HA
    • ¡Possible fainting
    • ¡BP Bottoms Out
  22. complications of impaired temp. control
    • žCaused by lack of
    • communication between the hypothalamus to cutaneous blood flow or sweat

    ¡“lack of hypothalamic control”

    žNever Shiver

    • žNo vasoconstriction
    • or dilation to regulate temperature

    • žDo no sweat below the
    • level of the lesion

    • žProfuse sweating
    • above the level of the lesion
  23. complications of respiratory impairment

    • ¡No innervation of the
    • diaphragm

    ¡Ventilator dependent

    žTetra C4-T1

    • ¡All 4 extremities
    • & trunk involved

    • ¡Decreased chest
    • expansion

    • ¡Decreased innervation
    • of intercostal, decreased respiration volume, increase activation of innervated
    • accessory muscles

    • žPara (Depends on the
    • Level)

    ¡LE & Trunk


    • ¡Abdominals and
    • external intercostal still intact
  24. complications of spasticity
    • žResults from a
    • release of an intact reflex arc from CNS

    • žActin and Myosin are
    • always firing

    • žHyper-reactive to
    • stretch reflex

    • žChanges below the
    • level of the lesion

    • žCan HELP or HINDER a
    • patient