Structure of Spinal Cord
Terms
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- What is the structure of the SC
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Diagram of SC spinal nerves and their innervations. - What is the etiology for SCI
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#1 MVA
#2 falls
#3 gunshot wounds
#4 sports (diving) - How many vertebrae are there?
- 33
- How many spinal nerve pairs are there?
- 31
- How many types of SCI are there? Name them.
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2:
Incomplete and Complete - What are the 4 types of incomplete SCI
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1 Central Cord
2 Brown sequard syndrome
3 Anterior cord syndrome
4 Cauda equina - Where is the damage for a Central Cord inj?
- Middle of the SC
- What is lost due to a central cord inj?
- Loss of: motor and sensory to arms but not legs.
- What is the etiology for a central cord inj?
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Whip lash
fall - Where is the damage for Brown sequard syndrome
- One side of cord is damaged while the other is spared
- What is the loss due to brown sequard damage?
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Motor and proprieoception of ipsilateral and
loss of sensation (pain, temp, touch) of contralateral side - What is the etiology for brown sequard syndrome?
- gunshot and stabbing
- Where is the damage for Anterior cord syndrome?
- Damage is to the anterior spinal artery
- What is loss due to anterior cord syndrome?
- motor, pain, temp, touch, sensation below lesion EXCEPT proprioception.
- What is the etiology for anterior cord syndrome?
- Gunshot and stabbing
- Where is the damage for cauda equina?
- The bundle of peripheral nerves that comes out at the bottom of the sacral
- What is the prognosis for cauda equina?
- Good as the damage is to the PNS vs the CNS.
- What are the 2 types of complete cord injuries
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quadraplegia (tetraplegia)
and
paraplegia - What parts of the body are affected in tetraplegic cases?
- arms, legs, trunk and pelvic organs (sex, bladder and bowel organs)
- What parts of the body are affected in paraplegic cases?
- legs, some trunk and some pelvic organs
- What is the prognosis for complete spinal injuries?
- depends upon the lesion: the lower the lesion the better the prognosis
- What is the 1st stage of posttraumatice progression?
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Spinal shock: (1-3 months) areas below lesion are *flaccid paralysis
*absent reflexes
*flaccid bladder
*no bowel control - What are possible medical tx?
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ventilator
traction bed - What is the 2nd stage of posttarumatice progression?
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(6-12 months)
*reflexes may resume
*spasticity may increase - What is the final stage of posttraumatice progression?
- 1 year post inj, tone fluctuations end
- What are the 9 complications of SCI?
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1 Skin Breakdown
2 Decreased Vital Capacity
3 Osteoporosis (from disuse)
4 Orthostatic hypotension
5 Autonomic Dysreflexia
6 Spasticity
7 Heterotropic Ossificaiton
8 Thermal Regulation
9 Urinary complications
10 Bowel complications - What causes skin breakdown?
- pressure, heat or skin shearing
- What are the 4 stages of skin breakdown (one of the SCI complications)
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1 Dark or red skin (epidermal layer)
2 Red open skin w/blister or scab (deeper epidermal layer damage)
3 Deep wound starts to drain; MS may show w/necrotic ulcer
4 All structures from epidermis to bone is destroyed - Describe the site of stage 1 skin breakdown? How is treated?
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Skin turn dark read, like when a blister is about to develop.
TX: relieve pressure until redness subsides - Describe the site of stage 2 skin breakdown? How is treated?
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Red open skin with blister or scab
TX: wound dressing used ad pressure is kept off site - Describe the site of stage 3 skin breakdown? How is treated?
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Skin breakdown is deep and wound drains. Muscle may show w/necrotic ulcer
TX: surgery may be necessary to close wound - Describe the site of stage 4skin breakdown? How is treated?
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All structures from epidermis to bone is destroyed: infection and bone decay.
TX: May require grafting - What is Decreased Vital Capacity?
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*Weakness or paralysis of the diaphragm, intercostal and latissimus dorsi ms:
*Consequences include risk for respiratory tract infections
*Symptoms include shallow cough, congestion and low energy levels - What is Osteoporosis?
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*Inability to lay down new bone due to no weight bearing on bones.
* in SCI usually developes 1 yr post inj due to disuse
* Will develop pathological bone fractures - How can we slow down osteoporosis of this type?
- daily use of standing frames ro standing box
- What is orthostatic hypotension?
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* Not life threatening
*hypotension when pt goes from supine to upright, or chgs position quickly.
*The blood pools in the ab or legs instead of head - What are the symptoms of orthostatic hypotension?
- dizziness, nausea, faint
- How do you treat orthostatic hypotension?
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lift legs above head
"face is pale, raise the tail"
If in W/C tilt the w/c back - What is autonomic dysreflexia?
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*Life threatening...pt can have stroke!
*Those w/T6 and above are prone to this complication
*A reflex of the autonomic nervous system due to stimulus from tight clothing, packed fecal, catheter blockage, extreme temp - What are the symptoms for Autonomic dysreflexia
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severe headaches, high blood pressure, sweating, face turns red
"face is red raise the bed" - What is the TX for Autonomic dysreflexia
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Check leg bag for kincks;
loosen clothing, ab binders and socks -
Which is more common in tetraplegic patients?
osteostatic hypotension or autonomic dysreflexia - autonomic dysreflexia
- Which complications are more typical in the acute stage of SCI?
- Orthostatic hypotension and autonomic dysreflexia
- What is spasticity?
- It is a SCI complication more common in higher level inj (quads)
- What increases spasticity?
- Stress, pain, illness and emotions
- What is heterotropic ossification?
- It is a SCI complication where bone starts to lay on tendons and ms: most often in hips and knees
- When can heterotropic ossification occur?
- 1-4 months post injury
- What are the symptoms of heterotropic ossification?
- swelling, warmth and redness
- What is the TX for heterotropic ossification?
- A lot of PROM
- What is Thermal regulation?
- a SCI complication during 1st yr. Pt may become too cold or hot. Pt's body assumes the external enviro temp
- What is Urinary complications
- SCI victims rely upon catheterization. Urine is a breeding ground for bacteria which can spread throughout urinary sys
- What are the symptoms for Urinary comp
- dark urine, fowel smelling, fever, chills, increased spasticity
- What is Bowel complications
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Constipatoin and impacted fecal.
May result in autonomic dysreflexia in T6 or above lesion