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Questions and Answers
What is the initial stage following an acute spinal cord injury characterized by complete loss of tone and reflexes?
Which symptom is associated with a gradual cause of spinal cord injury?
What is a common motor manifestation seen during the recovery stage after spinal shock?
Which of the following symptoms is often linked to bladder dysfunction in spinal cord injuries?
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If a spinal cord lesion occurs at the C5 level, which of the following signs would typically be expected?
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What effect does a spinal cord lesion above C4 have on respiratory function?
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Which symptom might indicate impaired sympathetic outflow due to a cervical spinal cord lesion?
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What kind of sensory loss occurs below the neurological level of a spinal cord lesion?
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What type of spinal cord injury affects all four limbs?
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Which condition refers to loss of motor or sensory function in the S4-S5 area of the spinal cord?
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What is the most common level of spinal cord injury?
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What type of spinal cord injury impacts only the lower limbs?
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Which of the following is a sign of lower motor neuron lesions at the level of the injury?
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Which type of spinal cord injury is characterized by preservation of some sensory and/or motor function?
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What is often a common clinical manifestation after a spinal cord injury?
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What is the flaccid stage of paralysis in spinal cord injuries?
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What type of injury commonly leads to central cord syndrome in older individuals?
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In Brown-Sequard syndrome, what is primarily affected due to the lateral hemi-section of the spinal cord?
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What is typically preserved in a patient with anterior cervical cord syndrome?
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What sensation is generally lost due to posterior cord syndrome?
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What is a common symptom of Conus medullaris syndrome?
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Which reflex is typically absent in patients with an epiconus lesion?
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What type of lesion results in the manifestation of cauda equina syndrome?
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Which symptom is NOT typically associated with anterior cord syndrome?
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At what level does the spinal cord typically end in adults?
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Which layer of the meninges is the deepest?
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Which of the following is a non-traumatic cause of spinal cord injury?
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What type of spinal cord injury occurs due to high-impact collisions twisting the spinal cord tissue?
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Which spinal cord tract is specifically responsible for motor control?
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How many segments does the spinal cord comprise?
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What type of injury mechanism occurs when the spinal cord is compromised due to vertebral body fragments?
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Which segment arrangement is correct for the thoracic vertebrae?
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Study Notes
Spinal Cord Anatomy
- The spinal cord is an extension of the brain running through the spinal canal, ending at the lower border of the 1st lumbar vertebra.
- It connects to the medulla oblongata above and the filum terminale below.
- It's divided into 31 segments.
- Each segment has four roots: a ventral and a dorsal root for each half.
- The dorsal root has an oval swelling called the dorsal root ganglion.
- Three meningeal layers surround the spinal cord: Dura mater (superficial), arachnoid mater, and pia mater (deep).
- The spinal cord consists of gray matter surrounded by white matter.
- The gray matter resembles the letter "H" in a transverse section, with two anterior and two posterior horns.
- The white matter contains ascending and descending nerve fibers arranged into tracts.
Causes of Spinal Cord Injuries
- Non-traumatic (16%): secondary to disease, infection, and congenital defects.
- Trauma (84%): most common causes include motor vehicle and motorbike accidents, falls, sports (water-based activities), and work-related injuries.
Mechanisms of Spinal Cord Injury
- Distraction: occurs when the bony spine is hyperextended due to rapid acceleration and deceleration injuries.
- Compression: results from axial loading, compromising the spinal cord due to encroachment of vertebral body fragments or intravertebral discs.
- Torsional injuries: result from high-impact collisions that twist and tear spinal cord tissue.
- Penetrating trauma: directly damages the spinal cord, particularly vulnerable in the lower cervical or upper lumbar regions.
Classification of Spinal Cord Injuries
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Level (site) of lesion:
- Cervical: Tetraplegia (Quadriplegia)
- Below cervical: Paraplegia
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Cause:
- Traumatic
- Non-traumatic: congenital, infection, vascular, neoplastic, etc.
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Injury (Impairment):
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Complete lesion: No motor or sensory function in the S4-S5 area of the spinal cord.
- Motor Function: Inability to voluntarily contract the anal sphincter.
- Sensory Function: Loss of deep anal pressure or light touch/pinprick sensation in the perianal area.
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Incomplete lesion: Some preservation of sensory and/or motor function in the S4-S5 area of the spinal cord.
- Types: central cord, Brown-Sequard, anterior cord, posterior cord, conus medullaris, and epiconus.
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Complete lesion: No motor or sensory function in the S4-S5 area of the spinal cord.
Clinical Picture
- Local Manifestations: Pain, local tenderness, swelling, or deformity at the site of the lesion.
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Lower Motor Neuron Signs:
- Motor: Muscle weakness or paralysis.
- Sensory: Hyposthesia (decreased sensation) or anesthesia (loss of sensation).
- Sphincters: Retention of urine and stool in S3-5 lesions.
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Upper Motor Neuron Signs:
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Paralysis: Impaired muscle power below the neurological level of the lesion.
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Stages:
- Flaccid Stage: Initial stage lasting from several hours to weeks, characterized by complete loss of tone and reflexes.
- Spastic Stage: On recovery from the shock stage, hypertonia, hyperreflexia, positive Babinski sign, and clonus develop.
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Stages:
- Sensory Loss: Impaired superficial and deep sensations below the neurological level of the lesion.
- Loss of Bladder and Bowel Control: Retention of urine in the flaccid stage followed by incontinence (reflex emptying) in the spastic stage.
- Sexual Dysfunction: Linked to bladder involvement.
- Impaired Sympathetic Outflow: More severe in cervical than thoracic level lesions, leading to impaired temperature control, hypertension, and bradycardia.
- Respiratory Problems: Lesions above C4 cause diaphragm paralysis, lower cervical lesions cause intercostal muscle and abdominal paralysis, reducing vital capacity.
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Paralysis: Impaired muscle power below the neurological level of the lesion.
Complete Lesion at C5 Segment
- Weakness and Atrophy: Deltoids, supraspinatous, infraspinatous, and rhomboids (LMNL).
- Biceps Reflex: Present.
- Hyposthesia or Anesthesia: Lateral aspect of the shoulder.
- UMNL: Motor and sensory below C5, including sphincters.
Incomplete Spinal Cord Injury Patterns
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Central Cord Syndrome:
- Commonly Occurred: Hyperextension injuries of the cervical spine in older people with cervical spondylosis.
- Symptoms: More severe paralysis of the upper limbs than the lower limbs.
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Brown-Sequard Syndrome:
- Caused: Damage to one side of the spinal cord due to penetrating injuries.
- Symptoms: Ipsilateral motor and proprioception loss, contralateral pain and temperature loss.
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Anterior Cord Syndrome:
- Caused: Flexion injury damaging the anterior two-thirds of the spinal cord, often due to vascular insult to the anterior vertebral artery.
- Symptoms: Preservation of light touch and proprioception, but loss of motor function, pain, and temperature sensation.
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Posterior Cord Syndrome:
- Caused: Damage to the back of the spinal cord.
- Symptoms: Loss of proprioception below the level of injury, but motor function, pain, temperature, and light touch sensations are usually intact.
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Conus Medullaris Syndrome:
- Caused: S3,4,5 segment lesion.
- Symptoms: Early urinary and faecal incontinence, impotence, impaired sensation in the saddle-shaped area, no motor or sensory disability in the lower limbs.
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Epiconus Lesion:
- Caused: L4,5 S1,2 segment lesion.
- Symptoms: Weakness or paralysis in the lower limbs, absent ankle reflex, intact knee reflex, sensory loss from L4-S2, and potential bladder precipitancy.
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Cauda Equina Syndrome:
- Caused: Injury to the cauda equina, lumbar and sacral nerve roots.
- Symptoms: Motor weakness of LMN nature in one or both lower limbs, sensory loss, and bladder and bowel dysfunction.
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Description
Test your knowledge on spinal cord anatomy and the various causes of spinal cord injuries. This quiz covers the structure, segments, and protective layers of the spinal cord, as well as traumatic and non-traumatic injury causes. Perfect for students studying anatomy and medicine.
