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Spinal Cord Injury (Clinical Manifestions (SCI Syndromes (Brown-Sequard…
Spinal Cord Injury
Clinical Manifestions
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SCI Syndromes
Brown-Sequard syndrome
Damage to one side of spinal cord causing ipsilateral weakness, contralateral pain/temp loss
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Spinal shock
loss of DTR's, voluntary control below level of lesion that persists for weeks to months
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Pathogenesis
Initially, necrotic death of axons, then, progression of tissue injury in both directions from injury (immune cells trigger apoptosis)
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Neuropraxia
Dramatic, transient neurologic deficits especially after neurologic injury
Syringomyelia - appears over time; sharp pain is common initial symptom, Horner syndrome, phantom sensations, autonomic changes
Medical Management
Diagnosis
X-rays are good diagnostic tool of cervical SCI; if not adequate, CT scan can be used; MRI good for chronic SCI
Treatment
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Strategies for Future consideration ie. stem cell transplantation, use of Schwann cells for repair figure 34.16, peripheral nerve grafting
Prognosis
Depends on level of injury, muscle strength, initial ASIA scale rating, age (younger has better prognosis)
Most motor recovery in first 6 months; more than half of SCI will have return of some neurologic function
Compression fractures have most favorable prognosis; crush fractures have the least chance of return of function
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Higher rated QOF from employment status , motor level/completeness of injury, ambulatory mode
Chronic cough, chronic phlegm, persistent wheeze, dyspnea with ADL's, and lower FEV and FVC are associated lower rated QOF
Incidence
Higher risk in males, mean age 40 y.o.; higher survival rate in older populations
Primary cause is MVA, followed by falls
Etiology
Traumatic SCI
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Contusion: glial tissue and spinal cord surface intact, may be loss of central grey and white matter
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