- Ventilator independent- Has biceps, deltoid, and can flex elbow, but lacks wrist extension and supination needed to feed oneself- Independent ADL’s; electric wheelchair with hand control, minimal manual wheelchair function
- Various return of B/B and sexual function- Walking with minimal or no assistance
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A 32-year-old man is brought to the Emergency Department after cervical spine trauma. Physical examination has classified his injury as ASIA B at the C6 level. All of the following exam findings are expected in this patient EXCEPT?
Sensation intact in the long finger
Sensation intact over the medial aspect of the forearm
5/5 strength in deltoid function
2/5 strength in triceps function
0/5 strength in the instrinic hand muscles
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An 18-year-old male is evaluated for a suspected spinal cord injury. His neurological exam shows diminished sensation below the T7 level. His bulbocavernosus reflex is intact. Which physical finding of motor function, below the affected neurological level, would classify this injury as an ASIA B according to the American Spinal Injury Association impairment scale?
More than half of the major muscles demonstrate palpable or visible muscle contraction
At least half of key muscles have a muscle grade of 5.
More than half of key muscles have a muscle grade less than 3.
At least half of key muscles have a muscle grade of 3 or more.
No motor function preserved below affected neurological level
A 36-year-old male involved in a high speed motor vehicle accident is found on exam to have Grade 2 of 5 motor strength in 80% of his key muscle groups in his lower extremity. His perianal sensation and rectal tone are intact. A bulbocavernosus reflex is present. His sensation is decreased from a point at the intersection of the mid-clavicular line and the 4th intercostal space at the level of the nipples distally. Based on the American Spinal Injury Association (ASIA) classification system, what ASIA grade is he?
A 23-year-old man falls down a flight of stairs while intoxicated and is brought to the emergency room the following morning. On physical exam he has no motor function in his upper and lower extremities. Sensory exam shows diminished but present sensation in the perianal area and in the lower extremities. Reflex exam shows his bulbocavernosus reflex is intact. The inital CT and MRI are seen in Figures A and B. According to the American Spinal Injury Association (ASIA), how would this injury be classified?
A 49-year-old male fell from a height of 10 feet while cleaning his roof. He sustained the isolated injury shown in Figures A and B. Upon transfer from the outside hospital 10 hours later, he has 0/5 motor strength in bilateral lower extremities, no sensation distal to umbilicus, and an intact bulbocavernosous reflex. He has no perianal sensation or rectal tone. He received no medical management at the outside hospital. Which of the following is the most appropriate use of methylprednisolone in this patient.?
Initiate high-dose methylprednisolone with a loading dose of 30mg/kg and a drip of 5.4 mg/kg/hr
Initiate high-dose methylprednisolone, without a loading dose, at 5.4 mg/kg/hr
Do not initiate treatment with methylprednisolone
Initiate high-dose methyprednisolone if his neurologic status does not improve over the next 14 hours
Administer a one-time dose of methylprednisolone at a dose of 30 mg/kg
A 52-year-old male is involved in an altercation where his neck was twisted and extended with force. Upon presentation he complains of neck pain, and loss of ability to stand or ambulate. On physical exam, he has Grade 3 motor strength in the majority of his muscles groups in his upper and lower extremities. His sensory is intact in all four extremities, and his bulbocavernosus reflex is intact. Sagittal and coronal computed tomography are shown in Figure A and B respectively. The patient's neurologic condition is best classified as?
What percentage of patients with a spinal cord injury suffer from Major Depressive Disorder?
Less than 5%
5 to 20%
20 to 50%
50 to 75%
Greater than 75%
All of the following are attributed to the loss of supraspinal control of the sympathetic nervous system that commonly occurs in patients with spinal cord lesions at T-6 or higher EXCEPT
Functional electrical stimulation is used in the rehabilitation of patients with spinal cord injuries. This rehabiliation method has the greatest functional effect on which of the following?
Dorsal root ganglion
A 30-year-old male is involved in a motor vehicle accident and sustains a fracture-dislocation of the cervical spine. On physical exam he has absent distal motor function, absent sensation, absent rectal tone, and an intact bulbocavernosus reflex. Which term best describes this spinal cord injury pattern?
Central cord syndrome
Incomplete spinal cord injury
Complete spinal cord injury
A 16-year-old male is involved in a diving accident six months ago that leads to a spinal cord injury. On physical exam he has 5 out of 5 deltoid and biceps strength. He has good brachioradialis muscle tone and 5 out of 5 bilateral wrist extension. He has 0 out of 5 wrist flexion and triceps strength. He has no anal sphincter tone, absent perianal sensation, absent lower extremity sensation, and an intact bulbocavernosus reflex. He has no motor tone in his lower extremities. How would you define this patients neurologic deficit.
Incomplete C5 spinal cord injury (ASIA A)
Complete C5 spinal cord injury (ASIA E)
Complete C6 spinal cord injury (ASIA A)
Complete C7 spinal cord injury (ASIA A)
Incomplete C7 spinal cord injury (ASIA B)
Which of the following best describes a patient's functional level with a complete C5 spinal cord injury?
Electric wheelchair with only head or chin control
Electric wheelchair with hand control
Limited use of manual wheelchair, can drive car with manual controls
Long-distance use of a manual wheelchair
Fully independent transfers
Following an acute spinal cord injury a patient presents with systemic hypotension and relative bradycardia. His bulbocavernosus reflex is present. This is characteristic of what type of response in acute spinal cord injuries?
A 2-year-old child falls down a flight of stairs and is found to have spinal cord injury without radiographic abnormality (SCIWORA). What is the most important predictor of her neurologic outcome?
Mechanism of injury
Severity of initial neurologic injury
Injury pattern of fracture or dislocation
Location of spinal cord injury
Age of patient
Which of the following scenarios would be most appropriate for posterior deltoid-to-triceps transfers?
Axillary nerve injury
C6 ASIA A Spinal Cord Injury with 5/5 biceps and 4/5 brachioradialis
Erb's palsy with waiters tip deformity
C5 ASIA C Spinal Cord Injury with 3/5 deltoid and 2/5 biceps
C5 ASIA D Spinal Cord Injury with 4/5 deltoid and 4/5 biceps
HPI - The patient is a 39-year-old male immigrant that become intoxicated and fell down the stairs. He was found the following morning, unable to move any of his extremities. He was brought to the emergency room via ambulance.
Would you have done anything differently with the odontoid fracture?
HPI - tetraplegic pt - Heterotopic ossification of both hip joints...
what is the preferred treatment choice for this patient?
HPI - Three days prior, patient was admitted due to a gunshot wound through the thorax. The pulmonary artery was transected while entering the spinal canal without damaging the vertebral body.
On imaging the T8 posterior structures are seen damaged with the bullet doing a traumatic laminectomy through the level. The disc material and vertebral body was spared, however the bullet trajectory can be seen crossing the spinal canal.
How would you treat this SCI given limited resources?