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Pathology of the Spinal Cord: Congenity Injury
- Occurs in utero, present at birth
- Defect in neural tube closure
- Spina Bifida Occulta: lack of a bony arch, may be asymptomatic
- Spina Bifida Cystica: talking about neural portion, bag external, filled w/ CSF
- ⇒Meningocele: just the meninges external
⇒ Myelomeningocele: meninges and part of cord external
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Pathology of the Spinal Cord: Traumatic
- Trauma: result of high velocity impact (indirect or direct)
- Non-traumatic mechanisms: circulatory insult, compression/subluxation, inflammatory process (i.e. transverse myelitis)
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Complete Injury
- No preservation of motor/sensory even in lowest sacral level
- Etiology: congenital, traumatic, stroke
- Presentation: loss of motor, sensory, autonomic functions below injury (problems w/ bowel and bladder)
- Tetraplegia (quadriplegia)/Paraplegia
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Incomplete Injury
- Preservation of motor and/or sensory functions below level of injury (sacral region)
- Can see some preservation of extrapyramidal tracts (synergies, high tone)
- Types:
- Anterior Cord Syndrome
- Posterior Cord Syndrome
- Central Cord Syndrome
- Brown Sequard Syndrome
- Cauda Equina Injuries
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Anterior Cord Syndrome
- Anterior 2/3 of spine
- Dorsal column preserved
- May have sacral sparing, know where they are (proprioception)
- No volitional motor movement below level of injury
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Posterior Cord Syndrome
- Loss of dorsal column (just sensory issues)
- Have no sense of where they are in space (may be in a WC despite having motor intact)
- B12 deficiency common cause
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Central Cord Syndrome
- Hyperflexion/hyperextension injury
- Can have some preservation of lumbar/sacral sensory & motor (movement of legs/bowel & bladder)
- Height of injury determines how involved pt is
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Brown Sequard Syndrome
- Not common ("knifing situations")
- Unilateral trauma
- Think of it as a hemisection of cord (lose motor on one side and sensory deficits on the other)
- Can also have sacral sparing
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Cauda Equina Injuries
- Seen w/ spina bifida clients
- Can also be due to trauma/knifing/gunshot incidents
- Motor function - usually in great shape, reproductive function & bowel/bladder control affected
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Syringomyelia (Syringobublia)
- Cyst formation of central cord that progresses peripherally (longitudinally)
- Active disease process (progressive)
- Death when cardiac-respiratory centers in brain affected
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Myelitis (Transverse-, Polio-, Meningo-)
- Inflammatory process
- Affecting cord & causing destruction
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Syrinx
- Damaged cells stay weakened after injury ⇒ die at a faster rate (rapid aging of the spine)
- CSF filled cavitation that forms
- Cell death ⇒ can see changes in function (sensory & motor)
- Often seen 10-20 years after initial spinal cord injury
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