5.1 O) Ii) Surgical Trauma Spinal Cord Syndromes

Front 1

List the Incomplete Spinal Cord Syndromes.

Back 1

1. Anterior Cord Syndrome
2. Central Spinal cord Syndrome
3. Brown Sequard Syndrome
4. Cauda Equina

Front 2

What are the causes of Anterior Spinal Cord Syndrome (3) ?

Back 2

1. Direct anterior cord compression
2. Flexion of cervical spine
3. Thrombosis of anterior spinal artery

Front 3

What are the Symptoms / Signs of Anterior Cord Syndrome ?

Back 3

Below level of the lesion :

1. Complete paralysis
2. Loss of pain and temperature

Preservation of proprioception and vibration

Front 4

Which of the following is incorrect regarding Spinal Cord Syndromes ?
A. Sacral sparing refers to preserved perianal sensation and voluntary rectal motor function.
B. The most common cord syndrome is the Central Cord Syndrome.
C. A C5 Cord level injury is associated with a 100% ventilation requirement.
D. A Patient with a cervical Spinal Cord injury at C5 and above should be considered for mechanical ventilation before respiratory failure arises.

Back 4

C. 50% Short Term Ventilation

C4 = 100% Short Term Ventilation (STV)
C3 = 100% STV and 50% Long Term Ventilation Rate

Front 5

What are the Symptoms and Signs of a Central Cord Syndrome ?

Back 5

Below the level of the lesion :

1. Quadriparesis
Upper Limbs > Lower Limbs
2. (Some) loss of pain and temperature

Front 6

Which of the following is incorrect regarding Spinal Cord Syndromes ?
A. The Lateral Spinothalamic Tract carries fibres for pain and temperature.
B. The fibres of the Spinothalamic tract cross before ascending.
C. The Motor tract is the Lateral Pyramidal tract.
D. Fibres for both motor and sensory tracts have the lower limbs most medial, with upper limbs laterally placed.

Back 6

D. The opposite.
Upper limbs medially
Lower limbs laterally
Hence, Central cord syndrome has Upper > lower limb symptoms / signs

Front 7

List the causes of a Central Cord Syndrome (3)

Back 7

1. Hyperextension Injury (Older patients)
2. Spinal cord ischaemia (disruption of blood flow).
3. Cervical spinal stenosis.

Front 8

What are the Symptoms and signs of Brown Sequard Syndrome ?

Back 8

1. Ipsilateral Spastic paresis
2. Ipsilateral loss of proprioception and vibration sense.

3. Contralateral loss of pain and temperature
( Fibres cross before ascending).

Front 9

What are the causes of Brown Sequard Syndrome ?

Back 9

1. Transverse Hemisection of Spinal cord.
2. Unilateral cord compression.

Front 10

In regards to Spinal Shock and neurogenic Shock, which of the following is incorrect ?
A. Haemorrhagic Shock must be excluded before assuming traumatic hypotension is due to Neurogenic shock.
B. Neurogenic Shock is characterised by hypotension and bradycardia.
C. Spinal Shock is "Spinal Cord concussion", and is common in the immediate period after spinal cord injury.
D. Neurogenic Shock is parasympathetic denervation.

Back 10

D. Sympathetic denervation

Front 11

List the high priority secondary injury - prevention issues to address with spinal cord injury (6).

Back 11

1. Mishandling
2. Hypotension
3. Hypoxia
4. Seizures
5. Hypoglycaemia
6. Hyponatraemia

Front 12

List the Clinical Findings of Spinal Shock .

Back 12

1. Flaccid paralysis
2. Absence of all distal reflexes
eg. Bulbocavernosus
3. Bowel and bladder dysfunction
4. Priapism

Front 13

In regards to Neurogenic Shock, which of the following is incorrect?
A. It is the effects of SYMPATHETIC DENERVATION after spinal cord injury.
B. There is unopposed vagal tone
C. The injury usually develops with injury below T6.
D. Management includes IV fluids + atropine + vasopressors (Noradrenaline).

Back 13

C. The injury does not usually develop below T6.

Front 14

Which of the following is incorrect regarding Spinal Shock ?
A. It is the loss of motor + sensory function + reflexes.
B. It can exist for days - weeks after injury to the spinal cord.
C.It is usually associated with MRI / CT evidence of spinal cord injury.
D. There is now reduced support for steroids in Acute spinal cord injury (2013).

Back 14

C. It is usually WITHOUT demonstrable evidence of injury on imaging.