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32 Cards in this Set
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- Back
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Epidemiology of SCI:
-new cases per year in US? -Mean age: -Median age: -Male:Female |
-11,000 new cases/yr
-mean: 32.3 yrs -median: 27yrs -4:1 |
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Most common level of spinal cord injury?
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C5 (15%)
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Most common etiologies of SCI?
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-MVA (40%)
-Violoence (21%) -Falls (21%) -Sports (8%) |
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List the C2-C8 ASIA key sensory points.
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C2 - occipital protuberance
C3 - Supraclavicula fossa C4 - Top of AC joint C5 - Lateral antecubital fossa C6 - Dorsal proximal thumb C7 - Dorsal proximal middle finger C8 - Dorsal proximal pinky finger |
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List the thoracic ASIA key sensory point (5).
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T1 - medial antecubital fossa
T2 - apex of the axilla T4 - medial to nipple T10 - lateral to umbilicus T12 - inguinal ligament |
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List the L1-L5 ASIA key sensory points.
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L1 - B/t T12 and L2
L2 - medial anterior thigh L3 - medial anterior knee L4 - Medial malleolus L5 - medial dorsal foot |
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List the S1-S5 ASIA key sensory points.
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S1 - inferior lateral malleoulus
S2 - popliteal fossa S3 - ischial tuberosity S4-5 - perianal tissue |
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List the ASIA key muscles for C5-C8
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C5 - elbow flexors
C6 - wrist extensors C7 - elbow extensors C8 - FDP of 3rd digit |
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Which muscle group would you test for T1 while perfomring an ASIA exam.
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finger abductors
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List the ASIA key muscles for L2-S1
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L2 - hip flexors
L3 - knee extensors L4 - Ankle dorsiflexion L5 - EHL S1 - plantarflexion |
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This ASIA grade is defined by sensory but no motor function preserved below the neurolgical level and includes S4-5.
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ASIA B incomplete
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This ASIA grade is defined buy preservation of motor function below the neurolgic level with more than half of the key muscles having grade of <3.
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ASIA C incomplete
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This ASIA grade is defined by motor function preservation below the neurologic level, and at least half of the key muscles below that level have a grade of > or = to 3.
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ASIA D incomplete
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This ASIA grade is defined by intact sensory and motor function.
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ASIA E
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This SCI syndrome may be caused by retropulsed discs, aortic clamping during surgery, or lesions of the anterior spinal artery.
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Anterior cord syndrome
Describe the sx's |
Variable loss of motor and pinprick sensation, with preservation of light touch and proprioception intact. (poor prognosis)
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This spinal cord syndrome results in ipsilateral weakness, hyperreflexia, and proprioceptive loss and contralateral loss of pinprick and temperature sensation.
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Brown-Sequard
(cord hemisection) *best prognosis for ambulation compared to other cord syndromes |
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This spinal cord syndrome may be due to neural canal compression fractures of the pelvis, sacra\um, or spine at L2 or below.
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Cauda equina
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A 60 yo male presents to your clinic with c/o bl LE weakness and severe low back pain radiating down both LE. On exam patellar and achilles tendon reflexes are trace on the left and absent on the right. He smells of urine and is incontinent of bowel during the exam. You order an emergent LS-spine MRI and consult surgery because you are concerned he may have what dx?
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Cauda equina
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This spinal cord syndrome is typically seen in older persons with cervical spondylosis following neck hyperextension injury, resulting in UE>LE limb involvement and sparing of sacral segments
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Central Cord Syndrome
*ant/post cord compression due to inward bulging of ligamentum flavum during hyperextension of a stenotic canal |
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A patient with this spinal cord level will be ventilator-dependent, I with power w/c, D for all care, and I for directing care
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C1-C3
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A patient with this spinal cord level will be possibly breathing without a ventilator and may use a mobile upper arm support for limited ADL's if there is some elbow flexion and deltoid strength
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C4
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A patient with this spinal cord level may be I with manual w/c on non-carpeted surface, may be driving an adapted van, but may require A for secretion management and self-cleaning
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C5
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A patient with this spinal cord level will be I with feeding except cutting food, I for most upper body ADLs; males will be I with CIC, but females are usually D. May transfer I with sliding board.
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C6
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A patient with this spinal cord level will be essentially I for ADLs except a few lower body ADLs and women have difficulty with CIC
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C7
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A patient with this spinal cord level will be completly I with ADLs and mobility using a w/c and car.
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C8
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This occurs in 48-85% of SCI patients at T6 or above when a sensory impulse below the level of injury causes reflex sympathetic vasoconstriction leading to a spike in BP resulting in baroreceptor-mediated bradycardia.
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Autonomic Dysreflexia
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What is the FIRST thing to do if your patient is demonstrating signs of Autonomic Dysreflexia?
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Raise the head of the bead, then survey for precipitating causes. (foley kink, urinary retention, fecal impaction, pressure ulcers, cellulitis, DVT, ingrown toenail, diverticulitis, perforated bowel, gi bleed, nephrolithiasis, vaginitis, ovarian rupture, testicular torsion, or PE!)
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If your patient with autonomic dysreflexia experiences no relief with sitting up after 2-5 mins, which meds might you consider?
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Nifedipine: 10 mg bite and swallow
Nitro: 0.4mg SL others: hydralazine iv, or po clonidine |
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What type of long-term GU follow-up is indicated after SCI?
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-24hr CrCl qyear
-Renal US qyear -Urodynamics q1-2yrs -Cystoscopy qyear after 10yrs or 5yrs if a heavy smoker |
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What percentage of women with SCI achieve orgasm?
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44-55%
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When does menses and reproductive function return after SCI in women?
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w/in 6 months
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Your patient with complete SCI wants to know if he will be able to have sex/children. You say?
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Erections yes, ejaculation rare, infertility is common
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