Spinal cord injury: Difference between revisions
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**Some loss of pain and temperature sensation also greater in upper extremities | **Some loss of pain and temperature sensation also greater in upper extremities | ||
*Prognosis good | *Prognosis good | ||
*Tx and work-up - consider IV methylprednisolone within 8 hrs of injury, surgery consultation, and cervical MRI | |||
===Brown-Sequard=== | ===Brown-Sequard=== |
Revision as of 00:33, 14 August 2014
Background
Anatomy
- Doral columns
- Proprioception, vibration touch
- Decussation at medulla
- Corticospinal Tract
- Voluntary motor
- Upper extremity fibers more central, lower extremity fibers more lateral
- Decussation at medulla
- Voluntary motor
- Spinothalamic
- Pain, temp, touch
- Decussates one level above entry point to spinal cord
Spinal Cord Syndromes
Complete Transection
- Higher lesions are a/w spinal shock and autonomic dysfunction
- Priapism implies a complete injury
- Sacral sparing excludes complete transection
- Perianal sensation, rectal tone, bulbocavernosus/cremasteric reflexes
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, vibration, and light touch
- Prognosis poor
Central Cord
- Etiology
- Hyperextension
- Disruption of blood flow to the spinal cord
- Cervical spinal stenosis
- Symptoms
- Quadriparesis (upper extremities > lower extremities)
- Some loss of pain and temperature sensation also greater in upper extremities
- Prognosis good
- Tx and work-up - consider IV methylprednisolone within 8 hrs of injury, surgery consultation, and cervical MRI
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
See Also
Source
Tintinalli