Spinal Cord Injury

independent function
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incomplete spinal cord injuryAny sensory or motor response at the S4-S5 level indicates what?complete cord paralysisIf both sensory and motor response at the S4-S5 level are absent then barring exception of injury at that level, it signifies what?sacral sparingPreservation of perianal sensation, rectal tone, or great toe flexion means intact S2-S5 and is called what?Spinal shockThe loss of all muscle tone and reflexes is called what?Spinal shock has resolvedIf spinal shock occurs, lesions cannot be deemed truly complete until when?Complete spinal cord injury (ASIA class A)If the S2-S5 reflexes have not returned within 24 hours, the injury is called what?TrueTrue or False: Complete spinal cord injury (ASIA class A), is associated with a poor prognosis and poor spinal cord function recoveryLowest level with sensory and motor functionThe neurologic level of injury is determined by what?Central cord syndromeIncomplete spinal cord injury where patients' central grey matter is affected with sparing of the surrounding outer spinal cordTetraparesis- weakness or paralysis in all 4 limbs with sacral sparingClinically, patients with central cord syndrome often present with what findings?TrueTrue or False: in central cord syndrome upper extremity function is often affected more than that of the lower extremities-Hyperextension injuries -Disruption of blood flow to the spinal cord -Cervical spinal stenosisCentral cord syndrome usually results from what?Anterior cord syndromeIncomplete spinal cord injury that occurs due to injury of the anterior spinal artery affecting the anterior two-thirds of the spinal cordMotor and sensory loss (pain, temperature) however proprioception, or body awareness of position and movement, is preserved due to sparing of the posterior spinal cordClinically, patients with anterior cord syndrome often present with what findings?Posterior cord syndromeRare incomplete spinal cord injury where there is loss of proprioception in an otherwise normal functioning spinal cordBrown-Sequard SyndromeIncomplete spinal cord injury to one side of the spinal cordIpsilateral motor function and proprioception loss with contralateral pain and temperature lossClinically, patients with Brown-Sequard syndrome often present with what findings?Penetrating spinal cord injuryBrown-Sequard syndrome usually occurs after what?-bowel and/or bladder dysfunction -decreased anal sphincter tone -saddle anesthesia -variable motor and sensory loss in the lower extremities -decreased lower extremity reflexes -sciaticaSigns and symptoms of Cauda Equina syndrome include what?Saddle anesthesiaSensory deficit over the perineum, buttocks, and inner thighs is calledFalseTrue or False: Bowel or bladder incontinence is a universal finding of Cauda Equina SyndromeEmergent MRI of the lumbosacral spinal cordClinical suspicion of Cauda Equina Syndrome warrants what diagnostic test?TrueTrue or False: Cauda equina syndrome is not a true spinal cord syndrome because the cauda equina is composed entirely of lumbar, sacral, and coccygeal nerve roots; therefore, injuries to this region produce peripheral nerve injuriesC3In general, lesions above what can cause immediate respiratory arrest?C5 or aboveExperts recommend that any patient with an injury at what level should have the airway secured by endotracheal intubation?-Assess DTR -Assess if any sacral sparringWhat assessments should be included in TSCI?•Perineal sensation •Anal wink •Rectal tone •Urine retention/incontinence •Priapism •Bulbocavernous reflexSacral sparring assessments include what?-good-quality CT scans of the cervical spine -3-view cervical spine series if CT not availableRadiographic studies for the "awake, symptomatic" TSCI patient should include what?-when the patient is asymptomatic -if dynamic flexion/extension of cervical radiographs are normal -if spine MRI done within 48 hours is normal -at the provider's discretion.For the "awake, symptomatic" TSCI patient, cervical immobilization can be discontinued when?TrueTrue or False: Flexion/extension imaging should not be attempted in the obtunded TSCI patient-Thin-cut CT with axial, coronal, and sagittal reconstructions, making sure to visualize both bone and soft-tissue imagingRadiographic studies for the "obtunded" TSCI patient should include what?TrueTrue or False: MRI has an added benefit of providing information regarding soft-tissue/ligamentous injury in the cervical spineNeurogenic shockType of distributive shock where a sudden loss of sympathetic tone as a result of injury to the cervical and upper thoracic spinal cordhypotension and bradycardiaHow is neurogenic shock manifested clinically?85-90 mmHgThe mean arterial blood pressure should be maintained between ________ for the first 7 days of TSCIHead injuryIt is important to rule out what condition that occurs in 25% of TSCI?T6Neurogenic shock occurs only in the presence of acute spinal cord injury above what?hemorrhageHypotension with or without shock with acute spinal cord injury below T6 is always going to be what?hemorrhageHypotension with spinal fracture alone without any neurologic deficit or spinal cord injury is usually going to be due to what?TrueTrue or False: Patients that have a spinal cord injury above T6 may not have classic physical findings associated with hemorrhage due to their autonomic dysfunction in the spinal cord injury itselfdelayed plantar and bulbocavernosus reflexesWhat reflexes are among the first to return as spinal shock resolves?days to weeks, but can persist for up to 6 monthsThe duration of spinal shock is variable, but generally lasts for how long?Deep vein thrombosis (10-18%)Patients with TSCI have an increased incidence of what, especially within the first 3 months?5%; 72 hoursPatients with complete spinal cord injury have a less than __ chance of recovery. If they are completely paralyzed at ______ they are not going to get better.50%If some sensory function is preserved in TSCI, their chance of walking again is up to about what?