Spinal shock

Spinal shock

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  SPINAL SHOCK By:Dr Ismah, Ortho department 1
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  Contents  Definition  Anatomy  Pathophysiology  Phases  Vs. neurogenic shock  Management 2
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  Definition 3 Immediate temporary loss of total power, sensation and reflexes below the level of injury  + Loss of bulbo-cavernous reflex  Usually recover within 24-48 hrs -oxford handbook-
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  4 bulbo-cavernous reflex
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  Anatomy 5 http://www.radiologyassistant.nl/ en/p4906c8352d8d2/spine-thoracolumbar- injury.html Dennis three column -spine stability
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  6 Walter B.Greene. Netter's Orthopaedics 1st ed. 2006
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  Pathophysiology 7 TRAUMA-- > SCI - causes a concussion like injury to spinal cord - total sensory and motor power loss and loss of all reflexes for initial some period - followed by then gradual recovery of reflexes  Reflexes in the SC caudal to the SCI are depressed (areflexia)  This state of sensory and motor loss along with total loss of reflexes following trauma is known as spinal shock  The 'shock' in spinal shock does not refer to circulatory collapse
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  Phases Phase TimePhysical exam findings Underlying physiological event 1 0-1 days Areflexia Loss of descending facilitation 2 1-3 days Initial reflex return Denervation supersensitivity 3 1-4 weeks Hyperreflexia Axon-supported synapse growth 4 1-12 months Hyperreflexia, Spasticity Soma-supported synapse growth http://www.nature.com/sc/journal/v42/n7/full/3101603a.html 8
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  Phase 1: A complete loss or weakening of all reflexes below the level of spinal cord injury  Spinal concussion caused the neurons involved in various reflex arcs and the neural input from the brain become hyperpolarized and unresponsive. 9
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  Phase 2 Characterized by the return of some reflexes. The first reflexes to reappear is the bulbocavernosus reflex  The reason reflexes return is the hypersensitivity of reflex muscles following denervation; more receptors for neurotransmitters are expressed and are therefore they are easier to stimulate. 10
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  Phases 3 and4  Characterized by hyperreflexia  Neurons below the injury attempt to reestablish the synapses 11
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  Spinal vs neurogenicshock 12 Spinal shock Neurogenic shock Definition Immediate temporary loss of total power, sensation and reflexes below the level of injury Sudden loss of the sympathetic nervous system signals BP Hypotension Hypotension Pulse Bradycardia Bradycardia Bulbocaverno Absent Variable sus reflex Motor Flaccid paralysis Variable Time 48-72 hrs immediate after SCI Mechanism Peripheral neurons become temporarily unresponsive to brain stimuli Disruption of autonomic pathways  loss of sympathetic tone and vasodilation http://www.orthobullets.com/spine/2006/spinal-cord-injuries
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  13 MANAGEMENT Immobilisation -Spinal board -Cervical collar 1) Monitor neurological status 2) Cord/cauda-equina Sx Methylprednisolone -given as bolus of 30 mg / kg body wt -followed by infusion at 5.4 mg / kg / hour for 24 hours Symtomatic medication: -Pain relief -Constipation DVT prophylaxis
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  The National SpinalCord Injury Study (NASCIS) 14  NASCIS 3 USA, 1997  High dose methylprednisolone  Prevent secondary injury of SCI  Rx start within 3 hrs for 24 hrs  Side effects: immunosuppression, GIT bleeding, hyperglycemia and ARDS
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  16 Thank you