loss of motor function, pain, and temp sensation due to involvement of ant neural structures
dorsal column is preserved (this spares proprioception & kinesthesia)
causes for ant cord syndrome (which means it's an incomplete lesion)
usually MVA or blow to back of head
injury to ant cord and/or its vascular supply (the ASA)
wedge fx of ant vert body due to compression, or fx of post elements
2 causes of central cord syndrome
degenerative narrowing of vertebral canal (often seen in elderly due to spinal stenosis)
for central cord syndrome, first there's cervical hyperextension or degen narrowing of vertebral canal, and this results in...?
edema a/o bleeding into central grey matter, most commonly in cervical region
how does central cord syndrome present?
loss of UE function w relative sparing of LE (walking quad)
these pts are often ambulatory but w greater falls risk 2/2 flaccid arms that can't use ADs or use arms for protection
Brown Sequard Syndrome
cord hemisection due to trauma w/split presentation
one side loses motor function and position sense due to damage of lateral corticospinal tracts and dorsal columns
other side loses pain and temp (beginning a few levels below lesion) due to damage to lat spinothalamic tract
in Brown Sequard syndrome, the side where the lateral corticospinal tracts and dorsal columns are damaged lose what?
motor function and position sense
in Brown Sequard syndrome, the side where the lateral spinothalamic tract is damaged loses what?
pain and temp (beginning a few levels below lesion)
posterior cord syndrome - typically due to what?
due to compression and tumor rather than trauma
what's damaged in posterior cord syndrom?
when the dorsal column is damaged, causing posterior cord syndrome, how does pt present?
loss of proprioception below lesion
wide based gait
cauda equina - what is it? presents how?
bc it's PNS there's a better prognosis for recovery than in CNS injuries
heterotopic ossification - what? where?
formation of bone in extra-skeletal soft tissue
it'll happen below level of injury both extraarticular and extracapsular
occurs adjacent to large joints (esp hips and knees, but elbows, shoulder, spine are targets too)
can cause functional limitations in 20% of pts
if hyeterotopic ossification is likely to happen, you may see elevated levels of what in the blood?
heterotopic ossification can lead to waht?
may require surgical resection
what's going on w cells to cause heterotopic ossification
multipotential connective tissue cells transform to osteoblasts and chondroblasts
what to do for heterotopic ossification if it's early stage? if it's late?
early - do PROM
late - don't do PROM (it's contraindicated 2/2 risk of pathological fracture)
why do SCI pts have higher incidence of osteoporosis?
following SCI, bone resorption is greater than formation
(can have this at same time as heterotopic growth)
normally there's a good balance btwn bone formation by osteoblasts and bone resorption by osteoclasts
this changes 2/2 changes mobility and lack of muscle contraction
in addition to osteoporosis, increased bone resorption can lead to what?
hypercalcuria which leads to renal calculi (kidney stones)
these stones may not be felt by SCI pt --> autonomic dysreflexia
a few ways to avoid osteoporosis in SCI pt
FES (functional electrical stim)
syringomyelia (post-traumatic cystic myelopathy) - what is it?
cavitation of central grey matter of spinal cord
can occur 2 months to 20 years post injury
syringomyelia (post-traumatic cystic myelopathy) - how does it present?
sensory loss, esp pain and temp loss, in UEs
syringomyelia - what's it associated with?
congenital abnormalities of the foramen magnum or base of skull
associated w late deterioration of function following SCI
ass. most frequently w pain, local or radicular
a nice quote describing syringomyelia
Syringomyelia is a chronic, progressive neurological condition and is sometimes associated with other neurological disorders such as Arnold-Chiari Malformation, osteoporosis, and scoliosis.
SM is characterised by a syrinx or pocket of fluid within the spinal cord. It results from an enlargement of the spinal cord due to excess fluid which builds up under pressure. The fluid is forced into the spinal cord causing debilitating effects.
The causes and symptoms of SM are numerous and no two cases are alike.
Common symptoms of SM can be motor impairment, severe pain, spacticity, numbness, weakness, and loss of sensitivity in the extremities.
how to diagnose & treat syringomyelia
diagnosis by history, confirmation by MRI
tx: laminectomy and drainage or surgical shunting
autonomic dysreflexia comes when there's a lesion where, and then a noxious sime where?
lesion at T6 higher
triggered by a noxius stim below level of lesion
in autonomic dysrflexia,what's happening in the body?
there was a noxious stim below level of lesion that caused a massive uncompensated autonomic outflow above he lesion
sypmtoms of autonic dysreflexia?
can be lethal or severe
what to do if your pt goes into autonomic dysreflexia
sit pt up to lower the BP
search for offending noxious stim (usually a kinked catheter)
(SCI systolic norm is 90-110, so 140-80 can mean significant HTN)
if symptoms don't improve call for help aspa
orthostatic hypotension happens in SCIs why? 3 influences
loss of LE SNS influences that cause vasoconstriction, leaving the pt in LE vasodilation