0071643192.pdf

Brown-Séquard Syndrome

■ Hemisection of the cordusually associated with penetrating trauma
■ Symptoms/exam:Typically see ipsilateral paralysis, loss of proprioception
and vibratory sensation, and contralateral loss of pain and temperature
sensation

SPINALSHOCK

MECHANISMS

■ Due to a partial or complete injury at or above T6 resulting in a transient
reflex depression of all cord function below the level of injury
■ Reflex function below the level of injury spontaneously returns (typi-
cally within 24–48 hours), at which time degree of cord injury can be fully
determined

SYMPTOMS/EXAM

■ Flaccid paralysis, including bowel and bladder, priapism
■ Bulbocavernosus reflex (anal sphincter contraction in response to squeez-
ing penile glans or pulling on the Foley) returns first.

NEUROGENICSHOCK

Diagnosis of exclusion in the trauma victim

MECHANISMS

Results from loss of sympathetic outflow in spinal cord injury, leading to
unopposed vagal tone

SYMPTOMS/EXAM

Hypotension, bradycardia, peripheral vasodilation

Spinal Cord Injury Without Radiographic Abnormality (SCIWORA)

■ Trauma patients with neurologic deficits consistent with a spinal cord injury
but with negative plain films and CT
■ SCIWORA is thought to be common in children, but also occurs in older
patients.
■ Central cord syndrome, which results from buckling of the ligamentum
flavum during hyperextension, is the classic form of SCIWORA in adults
(mainly the elderly).
■ MRI in patients with SCIWORA will often show spinal cord injury.

DIAGNOSIS

Any patient exhibiting signs of neurologic dysfunction following trauma, with
or without vertebral fracture, needs MRI with possible MRA for evaluation of
extent of cord and vascular damage.

TREATMENT

■ Spinal injury at or above C5 usually requires intubation because of weak-
ness of the diaphragm.

TRAUMA

Hemorrhagic shock: Patient is

cold, clammy, pale,

tachycardic.

Neurogenic shock: Patient is

warm, vasodilated,

bradycardic.

SCIWORA is defined by

neurologic deficits with

negative X-ray and CT. MRI is

often positive. Occurs mostly

in children < 8 years old and

in older adults.

C3, C4, C5 keep the

diaphragm alive (via

the phrenic nerve).