Diferencia entre revisiones de «Spinal cord injury»
| Línea 21: | Línea 21: | ||
**Sacral sparing manifests as intact great toe flexor function, perianal sensation, rectal motor function | **Sacral sparing manifests as intact great toe flexor function, perianal sensation, rectal motor function | ||
===Anterior | ===[[Anterior cord syndrome]]=== | ||
*Etiology | *Etiology | ||
**Direct anterior cord compression | **Direct anterior cord compression | ||
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*Poor prognosis | *Poor prognosis | ||
===Central | ===[[Central cord syndrome]]=== | ||
*Most common incomplete spinal cord injury | *Most common incomplete spinal cord injury | ||
*Etiology | *Etiology | ||
| Línea 44: | Línea 44: | ||
*Tx and work-up - consider IV methylprednisolone within 8 hrs of injury, surgery consultation, and cervical MRI | *Tx and work-up - consider IV methylprednisolone within 8 hrs of injury, surgery consultation, and cervical MRI | ||
===Brown-Sequard=== | ===[[Brown-Sequard syndrome]]=== | ||
*Etiology | *Etiology | ||
**Transverse hemisection of spinal cord | **Transverse hemisection of spinal cord | ||
Revisión del 13:05 4 feb 2015
Background
Anatomy
- Dorsal columns
- Proprioception, vibration
- Decussation at medulla
- Corticospinal Tract
- Voluntary motor
- Upper extremity fibers more central, lower extremity fibers more lateral
- Decussation at medulla
- Voluntary motor
- Spinothalamic
- Crude touch, pressure, pain, temperature
- Decussates 1-2 levels 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
- Can only be assessed AFTER spinal shock has ended, ie after return or bulbocavernosus/cremasteric reflexes
- Sacral sparing manifests as intact great toe flexor function, perianal sensation, rectal motor function
Anterior cord syndrome
- Etiology
- Direct anterior cord compression
- Hyperflexion injury of cervical spine
- Thrombosis of anterior spinal artery
- Symptoms
- Paraplegia below level of lesion
- Preservation of modalities carried by dorsal columns ie vibration, proprioception
- Poor prognosis
Central cord syndrome
- Most common incomplete spinal cord injury
- Etiology
- Hyperextension injury of cervical spine
- Disruption of blood flow to the spinal cord
- Cervical spinal stenosis
- Typically elderly patient with significant DJD (ligamentum flavum compresses cord, causing contusion to central portion of spinal cord)
- Symptoms
- Quadriparesis (characteristically with worse function in the UL than in the LL)
- Possible loss of pain and temperature sensation, also greater in upper extremities
- Good prognosis
- Tx and work-up - consider IV methylprednisolone within 8 hrs of injury, surgery consultation, and cervical MRI
Brown-Sequard syndrome
- Etiology
- Transverse hemisection of spinal cord
- Unilateral cord compression
- Symptoms
- Ipsilateral spastic paresis
- Ipsilateral loss of proprioception, vibration but contralateral loss of pain, temperature (ie 'sensory dissociation')
- Good prognosis
Cauda Equina
- Epidural compression syndromes
- Spinal cord compression
- Cauda equina syndrome
- Conus medullaris syndrome
See Also
Source
- Tintinalli
- SAEM
- eMedicine