Spinal cord trauma: Difference between revisions

Revision as of 21:55, 12 July 2011

Background

Complete lesion means absence of sensory and motor function below level of injury
- May be confused w/ spinal shock
Anatomy
- Doral column
  - Proprioception, vibration and touch
  - Decussation at medulla
- Lat corticospinal
  - Voluntary motor
    - Upper extremity fibers more central, lower extremity fibers more lateral
  - Decussation at medulla
- Ant spinothalamic
  - Pain, temp, light touch
  - Decussates one level above entry point to spinal cord

Spinal Cord Syndromes

Complete Transection

Higher lesions a/w spinal shock and autonomic dysfunction
Sacral sparing (perianal sens, rectal tone, or toe flexor) excludes complete transection

Anterior Cord

Etiology
- Direct anterior cord compression
- Flexion of cervical spine
- Thrombosis of anterior spinal artery
Symptoms
- Complete paralysis below the lesion with loss of pain and temperature sensation
- Preservation of proprioception and vibratory function
Prognosis poor

Central Cord

Etiology
- Hyperextension injuries
- Disruption of blood flow to the spinal cord
- Cervical spinal stenosis
Symptoms
- Quadriparesis (greater in upper extremities than lower extremities)
- Some loss of pain and temperature sensation also greater in the upper extremities
Prognosis good

Brown-Sequard

Etiology
- Transverse hemisection of spinal cord
- Unilateral cord compression
Symptoms
- Ipsilateral spastic paresis
- Loss of proprioception and vibratory sensation
- Contralateral loss of pain and temperature sensation
Prognosis good

Cauda Equina

Etiology
- Peripheral nerve injury
Symptoms
- Variable motor and sensory loss in the lower extremities
- Sciatica
- Bowel/bladder dysfunction
- Saddle anesthesia
Prognosis good

Source

DONALDSON 9/07 (Adapted from Lampe, Hockberger, Brower, and Mistry)

Authors:

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 ==Background==
-ANATOMY
+*Complete lesion means absence of sensory and motor function below level of injury
-# Doral column: proprioception, vibration and touch and decussate @ medulla
+**May be confused w/ spinal shock
-# Lat corticospinal: voluntary motor and cross @ medulla. Upper extremity fibres more centrally, lower extremity fibres more lateral
+*Anatomy
-# Ant spinothalamic: pain, temp. and light touch. Cross just one level above entry point to spinal cord.
+**Doral column
+***Proprioception, vibration and touch
+***Decussation at medulla
+**Lat corticospinal
+***Voluntary motor
+****Upper extremity fibers more central, lower extremity fibers more lateral
+***Decussation at medulla
+**Ant spinothalamic
+***Pain, temp, light touch
+***Decussates one level above entry point to spinal cord
 ==Spinal Cord Syndromes==
-===COMPLETE TRANSECTION===
+===Complete Transection===
-#higher lesions assoc w/ spinal shock &autonomic dysfunction
+*Higher lesions a/w spinal shock and autonomic dysfunction
-#sacral sparing (perianal sens, rectal tone, or toe flexor) excludes complete transection
+*Sacral sparing (perianal sens, rectal tone, or toe flexor) excludes complete transection
-===ANTERIOR CORD===
+===Anterior Cord===
-#hyperflexion injury or blood supply prob (hypotension or aortic dissection)
+*Etiology
-#loss of motor (variable) and pain/temp
+**Direct anterior cord compression
-#proprioception, vibration and touch spared (Doral column)
+**Flexion of cervical spine
+**Thrombosis of anterior spinal artery
+*Symptoms
+**Complete paralysis below the lesion with loss of pain and temperature sensation
+**Preservation of proprioception and vibratory function
+*Prognosis poor
-===CENTRAL CORD===
+===Central Cord===
-# hyperext of neck
+*Etiology
-#neuro deficit more pronounced in upper than lowe extremites
+**Hyperextension injuries
-#Loss of distal upper extremity pain, tem and strength
+**Disruption of blood flow to the spinal cord
+**Cervical spinal stenosis
+*Symptoms
+**Quadriparesis (greater in upper extremities than lower extremities)
+**Some loss of pain and temperature sensation also greater in the upper extremities
+*Prognosis good
-===BROWN-SEQUARD===
+===Brown-Sequard===
-#ipsilateral loss strength, vibration, position
+*Etiology
-#contralteral loss pain and temp
+**Transverse hemisection of spinal cord
+**Unilateral cord compression
-===CONUS MEDULLARIS/CAUDA EQUINA===
+*Symptoms
-#Difficulty w/ urination (retention or incont) and sphincter control
+**Ipsilateral spastic paresis
-#sexual dysf
+**Loss of proprioception and vibratory sensation
-#distal motor weakness
+**Contralateral loss of pain and temperature sensation
-#saddle anesthesia
+*Prognosis good
-#(Conus Medullaris usually B/L sxs; Cauda Equina is usually unilateral)
+===Cauda Equina ===
+*Etiology
+**Peripheral nerve injury
+*Symptoms
+**Variable motor and sensory loss in the lower extremities
+**Sciatica
+**Bowel/bladder dysfunction
+**Saddle anesthesia
+*Prognosis good
 ==See Also==
-Trauma: Spinal Fractures
+[[Spinal Fractures]]
+[[Neurogenic Shock]]
-Neuro: Neurogenic Shock
+[[Cord Compression]]
-Neuro: Cord Compression
 ==Source==