Nurc 424 Chapter 60 (spinal cord
injuries) Exam Latest Update
Etiology and pathophysiology of spinal cord injury - Answer Most common causes are
motor vehicle collisions (38%), falls (30%), violence (14%), sports injuries (9%), and
other miscellaneous causes (9%).
Types of spinal cord injury - Answer Primary injury and Secondary injury
What is Primary injury? - Answer initial mechanical, physical disruption of axons as a
result of stretch or laceration.
What is Secondary Injury? - Answer ongoing progressive damage that occurs after the
primary injury which may include ischemia hypoxia hemorrhage or edema.
Spinal Shock Spinal - Answer temporary, occurs in appox 50% of acute SCI cases.
Decreased reflexes, loss of sensation, absent thermoregulation, flaccid paralysis below
level of injury. Last days to weeks.
Neurogenic Shock - Answer loss of vasomotor tone caused by the injury. Hypotension
and bradycardia, loss of SNS (temp) & peripheral vasodilation, venous pooling and
decreased CO. Generally associated w/ cervical or high thoracic injuries.
Mechanism of Injury - Answer flexion, flexion-rotation (most unstable, often -> severe
neurogenic shock), hyperextension, vertical compression, extension-rotation, and
lateral flexion
Symptoms of injury C4 and above - Answer total loss of resp muscle Fx, mechanical vent
required.
Symptoms of injury below C4 - Answer diaphragmatic breathing.
Symptoms of injury above T6 - Answer decrease effect of SNS, bradycardia, peripheral
vasodilation = hypotension.
Symptoms of injury above T5 - Answer primary GI problems r/t hypomotility.
Injury C1-T1 can lead to - Answer tetrapalegia
Injury below T2 can lead to - Answer paraplegia
Degrees of Injury - Answer Complete cord, Central cord syndrome, Anterior cord
syndrome, Brown-Seqard Syndrome, posterior cord syndrome, conus medullaris and
cauda equina.
Complete cord injury - Answer total loss of sensory and motor function below the level of
injury.
, Incomplete cord injury - Answer mixed loss of voluntary motor activity and sensation
and leaves some tracts intact.
Central Cord Syndrome - Answer damage to central spinal cord, most commonly in C
region, more common in older adults. S/Sx = motor weakness and sensory loss in all
extremeties, upper is more affected than lower.
Anterior Cord Syndrome - Answer Damage to anterior spinal artery compromised blood
flow to anterior spinal cord, often caused by flexion injury. S/Sx = motor paralysis, loss
of pain/temp below SCI.
Brown-Seqard Syndrome - Answer Damage to ½ of spinal cord, typically from
penetrating injury. S/Sx Ipsilateral loss of motor Fx and position/vibratory sense,
vasomotor paralysis. Contralateral loss of pain/temp below SCI.
Posterior Cord Syndrome - Answer Compression/damage to posterior spinal artery -
RARE. Damage to dorsal columns = loss of proprioception. Pain/temp/motor Fx below
injury remain intact.
Conus Medullaris - Answer damage to Conus (lower portion of cord)
Cauda Equina (lumbar/sacral nerve roots) injury - Answer S/Sx Flaccid paralysis or
lower limbs and areflexic (flaccid) bladder/bowels.
Motor and Sensory Effects - Answer ASIA Impairment Scale to classify severity of
impairment using motor and sensory Fx. Sensory regions are called dermatomes. Used
to record changes in neuro status and identify rehab goals. Sensory Fx closely matches
Motor Fx at all levels.
Respiratory System Symptoms - Answer Above C3 = total loss of resp muscle Fx. C3-C5
= resp insufficiency d/t loss of phrenic nerve innervation to diaphragm. Complete injury
above C5 = intubate immediately. Incomplete above C5 varies. Fluid overload can cause
pulmonary edema. S/Sx of resp distress and need to inbutate = dyspnea, decreased vital
capacity, pCO2 > 20 above baseline
Cardiovascular System symptoms - Answer Above T6 = SNS dysfunction - bradycardia,
peripheral vasodilation -> decreased CO -> hypotension (neurogenic shock). NOTE: BB,
young pts, and older adults may not be tachycardic w/ hemorrhage.
Urinary System Symptoms - Answer Neurogenic Bladder = Bladder wall and sphincter
are overactive or flaccid causing high bladder pressure, urinary retention, and
incontinence.
Gastrointestinal System symptoms - Answer decreased GI activity -> gastric distention
and paralytic ileus. Higher SCI -> delayed emptying -> incrased HCL -> stomach ulcers.
Dyphagia. ABD bleeding can be hard to Dx as pain may be masked - look for
hypotension and low H/H. Neurogenic Bowel = above conus medullaris (hyperreflexic) -
constipation, below conus medullaris (areflexic) - impaired peristalsis/constipation
injuries) Exam Latest Update
Etiology and pathophysiology of spinal cord injury - Answer Most common causes are
motor vehicle collisions (38%), falls (30%), violence (14%), sports injuries (9%), and
other miscellaneous causes (9%).
Types of spinal cord injury - Answer Primary injury and Secondary injury
What is Primary injury? - Answer initial mechanical, physical disruption of axons as a
result of stretch or laceration.
What is Secondary Injury? - Answer ongoing progressive damage that occurs after the
primary injury which may include ischemia hypoxia hemorrhage or edema.
Spinal Shock Spinal - Answer temporary, occurs in appox 50% of acute SCI cases.
Decreased reflexes, loss of sensation, absent thermoregulation, flaccid paralysis below
level of injury. Last days to weeks.
Neurogenic Shock - Answer loss of vasomotor tone caused by the injury. Hypotension
and bradycardia, loss of SNS (temp) & peripheral vasodilation, venous pooling and
decreased CO. Generally associated w/ cervical or high thoracic injuries.
Mechanism of Injury - Answer flexion, flexion-rotation (most unstable, often -> severe
neurogenic shock), hyperextension, vertical compression, extension-rotation, and
lateral flexion
Symptoms of injury C4 and above - Answer total loss of resp muscle Fx, mechanical vent
required.
Symptoms of injury below C4 - Answer diaphragmatic breathing.
Symptoms of injury above T6 - Answer decrease effect of SNS, bradycardia, peripheral
vasodilation = hypotension.
Symptoms of injury above T5 - Answer primary GI problems r/t hypomotility.
Injury C1-T1 can lead to - Answer tetrapalegia
Injury below T2 can lead to - Answer paraplegia
Degrees of Injury - Answer Complete cord, Central cord syndrome, Anterior cord
syndrome, Brown-Seqard Syndrome, posterior cord syndrome, conus medullaris and
cauda equina.
Complete cord injury - Answer total loss of sensory and motor function below the level of
injury.
, Incomplete cord injury - Answer mixed loss of voluntary motor activity and sensation
and leaves some tracts intact.
Central Cord Syndrome - Answer damage to central spinal cord, most commonly in C
region, more common in older adults. S/Sx = motor weakness and sensory loss in all
extremeties, upper is more affected than lower.
Anterior Cord Syndrome - Answer Damage to anterior spinal artery compromised blood
flow to anterior spinal cord, often caused by flexion injury. S/Sx = motor paralysis, loss
of pain/temp below SCI.
Brown-Seqard Syndrome - Answer Damage to ½ of spinal cord, typically from
penetrating injury. S/Sx Ipsilateral loss of motor Fx and position/vibratory sense,
vasomotor paralysis. Contralateral loss of pain/temp below SCI.
Posterior Cord Syndrome - Answer Compression/damage to posterior spinal artery -
RARE. Damage to dorsal columns = loss of proprioception. Pain/temp/motor Fx below
injury remain intact.
Conus Medullaris - Answer damage to Conus (lower portion of cord)
Cauda Equina (lumbar/sacral nerve roots) injury - Answer S/Sx Flaccid paralysis or
lower limbs and areflexic (flaccid) bladder/bowels.
Motor and Sensory Effects - Answer ASIA Impairment Scale to classify severity of
impairment using motor and sensory Fx. Sensory regions are called dermatomes. Used
to record changes in neuro status and identify rehab goals. Sensory Fx closely matches
Motor Fx at all levels.
Respiratory System Symptoms - Answer Above C3 = total loss of resp muscle Fx. C3-C5
= resp insufficiency d/t loss of phrenic nerve innervation to diaphragm. Complete injury
above C5 = intubate immediately. Incomplete above C5 varies. Fluid overload can cause
pulmonary edema. S/Sx of resp distress and need to inbutate = dyspnea, decreased vital
capacity, pCO2 > 20 above baseline
Cardiovascular System symptoms - Answer Above T6 = SNS dysfunction - bradycardia,
peripheral vasodilation -> decreased CO -> hypotension (neurogenic shock). NOTE: BB,
young pts, and older adults may not be tachycardic w/ hemorrhage.
Urinary System Symptoms - Answer Neurogenic Bladder = Bladder wall and sphincter
are overactive or flaccid causing high bladder pressure, urinary retention, and
incontinence.
Gastrointestinal System symptoms - Answer decreased GI activity -> gastric distention
and paralytic ileus. Higher SCI -> delayed emptying -> incrased HCL -> stomach ulcers.
Dyphagia. ABD bleeding can be hard to Dx as pain may be masked - look for
hypotension and low H/H. Neurogenic Bowel = above conus medullaris (hyperreflexic) -
constipation, below conus medullaris (areflexic) - impaired peristalsis/constipation
