0071643192.pdf

■3 = Able to move against gravity
■2 = Able to move when gravity eliminated
■1 = Muscle fires, but no movement is generated
■0 = No muscle firing
■ Scoring reflexes
■ 0 to 4 scale with 2 being normal (0 = no reflexes, 4 = hyperactive
reflexes with clonus)
■ Complete injury results in complete loss of motor, sensory, and autonomic
function below level of injury.
■ Partial injury often presents as a spinal cord syndrome (Table 15.13).
■ Table 15.14 summarizes the findings in specific disease processes.

DIAGNOSIS

■ MRI is imaging of choice to evaluate for compression or mass lesion.
■ Lumbar puncture is indicated to further define a suspected inflammatory
or demyelinating process.

Spinal Epidural Hematoma

More likely to occur following spinal trauma or spinal procedures but may
occur spontaneously in patients with coagulopathy (eg, liver disease, anticoag-
ulation, thrombocytopenia).

SYMPTOMS/EXAM

■ Abrupt severe and radicular back pain
■ Weakness, loss of bowel/bladder and sensory deficits depending on degree
of compression

TABLE 15.13. Spinal Cord Syndromes NEUROLOGY

CHARACTERISTICFINDINGS

SYNDROME (BELOWLEVEL OFINJURY)LIKELYCAUSE COMMENTS

Central cord Bilateral motor weakness of upper Hyperextension injury of More common in elderly

extremities > lower extremities and narrowed cervical spinal patients

distal > proximal extremities canal

Brown-Sequard Ipsilateral motor weakness and Penetrating trauma Often partial syndrome

(cord hemisection) vibration/position loss Best prognosis

Contralateral pain and

temperature loss

Anterior cord Motor weakness, pinprick and light Infarction of anterior Poorest prognosis

touch loss. Preserved vibration spinal artery Preservation of posterior columns

and position sense

Cauda equina Urinary retention, decreased rectal Ruptured L4-5 disc Peripheral nerve (nerve root) injury

tone, saddle anesthesia, motor

weakness