injuries poisoning
Spinal Trauma
Symptoms and Signs of Spinal Trauma
The cardinal sign of spinal cord injury is a discrete injury level in which neurologic function above the injury is intact, and function below the injury is absent or markedly diminished. How to Assess Muscle Strength using the standard 0 to 5 scale. Specific manifestations depend on the exact level (see table In addition to motor and sensory function, upper motor neuron signs are an important finding in cord injury. These signs include increased deep tendon reflexes and muscle tone, a plantar extensor response (upgoing toe), clonus (most commonly found at the ankle by rapidly flexing the foot upward), and a Hoffman reflex (a positive response is flexion of the terminal phalanx of the thumb after flicking the nail of the middle finger). Vertebral injury, as with other fractures and dislocations, typically is painful, but patients who are distracted by other painful injuries (eg, long bone fractures) or whose level of consciousness is altered by intoxicants or head injury may not complain of pain. Complete spinal cord injury leads to Immediate, complete, flaccid paralysis (including loss of anal sphincter tone) Loss of all sensation and reflex activity Autonomic dysfunction below the level of the injury High cervical injury (at or above C5) affects the muscles controlling respiration, causing respiratory insufficiency; ventilator dependence may occur, especially in patients with injuries at or above C3. Autonomic dysfunction due to cervical cord injury can result in bradycardia and hypotension; this condition is termed neurogenic shock. Unlike in other forms of shock, the skin remains warm and dry. Overview of Arrhythmias and blood pressure instability may develop. Flaccid paralysis gradually changes over hours to weeks to spastic paralysis with increased deep tendon reflexes due to loss of descending inhibition. Later, if the lumbosacral cord is intact, flexor muscle spasms appear and autonomic reflexes return. In incomplete spinal cord injury, motor and sensory loss occurs, and deep tendon reflexes may be hyperactive, but sensation is preserved at least in segments S4 to S5. Motor and sensory loss may be permanent or temporary, depending on the etiology; function may be lost briefly due to concussion or more lastingly due to a contusion or laceration. Sometimes, however, rapid swelling of the cord results in total neurologic dysfunction that resembles complete cord injury; this condition is termed spinal shock (not to be confused with neurogenic shock). Symptoms resolve over one to several days, but residual disability often remains. Manifestations depend on which portion of the cord is involved; several discrete syndromes are recognized (see table). Brown-Séquard syndromeresults from unilateral hemisection of the cord. Patients have ipsilateral spastic paralysis and loss of position sense below the lesion, and contralateral loss of pain and temperature sensation. Anterior cord syndromeresults from direct injury to the anterior spinal cord or to the anterior spinal artery. Patients lose motor and pain sensation bilaterally below the lesion. Posterior cord function (vibration, proprioception) is intact. Central cord syndromeusually occurs in patients with a narrowed cervical spinal canal (congenital or degenerative) after a hyperextension injury. Motor function in the arms is impaired to a greater extent than that in the legs. If the posterior columns are affected, posture, vibration, and light touch are lost. If the spinothalamic tracts are affected, pain, temperature, and, often, light or deep touch are lost. Hemorrhage in the spinal cord resulting from trauma (hematomyelia) is usually confined to the cervical central gray matter, resulting in signs of lower motor neuron damage (muscle weakness and wasting, fasciculations, and diminished tendon reflexes in the arms), which is usually permanent. Motor weakness is often proximal and accompanied by selective impairment of pain and temperature sensation. Motor loss or sensory loss, or both, usually partial, occurs in the distal legs. Sensory symptoms are generally bilateral but usually asymmetric, affecting one side more than the other. Sensation is usually diminished in the perineal region (saddle anesthesia). Bowel and bladder dysfunction, either incontinence or retention, may occur. Men may have Erectile Dysfunction , and women diminished sexual response. Anal sphincter tone is lax, and bulbocavernosus and anal wink reflexes are abnormal. These findings may be similar to those of conus medullaris syndrome. Sequelae depend on the severity and level of the injury. Breathing may be impaired if the injury is at or above the C5 segment. Reduced mobility increases the risk of blood clots, Introduction to Urinary Tract Infections (UTIs) , contractures, 