Transient Ischemic Attack (TIA) Lumbar Spine Injuries

Injuries to the lumbar regions of the spinal cord can

• TIA may be a warning sign of a larger stroke. result to decreased control of the:

• Patients with possible TIA should be evaluated • Legs

by a physician. • Hips
• Urinary system
Spinal Cord Injury • Anus

Any injury to the spinal cord that is caused by trauma (LOSS OF AMBULATION, RETENTION, BLADDER
instead of disease. INCONTINENCE)

Depending on where the spinal cord and nerve roots are
damaged, the symptoms can vary widely, from pain to
paralysis to incontinence.
Specific Spinal Cord Injury Is
• Cervical
• Cervical injuries usually result in full or partial
tetraplegia (Quadriplegia).
• However, depending on the specific location and
severity of trauma, limited function may be
retained.
Sacral Spine Injuries
• Sexual function is associated with the sacral spinal
segments, and is often affected after injury
• The nerves that control a man's ability to have a reflex
erection are located in the sacral nerves (S2-S4) of the
spinal cord and could be affected after a spinal cord
injury (impotence)
Management
In the acute stage:

Specific Spinal Cord Injuries • Immobilization - spine board

• •Focus on ABC – prevent complications
• C-1/C-2 = often result in loss of breathing, • Hospitalization - surgery PRN
necessitating mechanical ventilators or • Medication
phrenic nerve pacing • Blood transfusion
• Infection control
• C3 vertebrae and above = results in loss of • Early Rehabilitation
diaphragm function, necessitating the use of a
ventilator for breathing. Management
In the rehabilitation phase:
• C4 = significant loss of function at the biceps
and shoulders. Main goal: Improvement of locomotor function

• C5 = potential loss of function at the • Early mobilization - to decrease chances of

shoulders and biceps, and complete loss of contractures or mal union, enhance circulation
function at the wrists and hands. and promote functioning

• C6 = limited wrist control, and complete loss • Bladder and bowel training
of hand function.
Teach patient the following:
• C7 and T1 = lack of dexterity in the hands
and fingers, but allows for limited use of arms • Bed mobility
• Transfers
NOTE: • Wheelchair mobility skills
• Use of assistive devices
• •Patients with complete injuries above C7 • Performing activities of daily living
typically cannot handle activities of daily living
and can’t function independently Prognosis

Thoracic Spine Injuries • In general, patients with complete injuries

recover very little
• Complete injuries at or below the thoracic spinal • patients with incomplete injuries have more
levels result in paraplegia (Paralyze of the lower hope of recovery
half)
Prognosis effects on:
• Hemiplegia - One side of the body if paralyze. • Age, financial, support etc.

Specific spinal Cord Injuries

• T1 to T8 = inability to control the abdominal
muscles, trunk stability is affected. The lower
the level of injury, the less severe the effects.
• T9 to T12 = partial loss of trunk and abdominal
muscle control
Cranial nerve disorder
Bell's Palsy
• An acute disorder of Cranial Nerve VII- the
facial nerve
• It develops with paralysis of the infratemporal
portion of the facial nerve resulting in ipsilateral
 paralysis of the face. (one - sided facial Trigeminal Neuralgia (CRANIAL NERVE V)
paralysis)
• Tic Douloureux (tic dolor'yu)
• Affects 40,000 people in the US/year (Phipps, • A disorder of the fifth cranial nerve
2006) characterized by tense knifelike pain along the
branches of the nerve.
• Cause: unknown • Incidence is high in women of middle and older
ages
• Possibly sensory ganglionitis of the CNS with
secondary muscle inflammation, palsy, vascular Trigeminal Neuralgia
autoimmune demyelination caused ischemia by
and • Usually associated with:
• Multiple Sclerosis
• Risk factors: those exposed to cold environment • Tumor/growth
• Compression from a nearby vessel (artery or
Manifestations vein)
• Clinical Manifestations
• Ipsilateral paralysis from the vertex of the skull
to the chin Subjective:
• Diminished taste anterior 2/3 of the tongue)
• Facial weakness • Burning pain lasting 1 to 15 minutes Pain is
• Decreased blinking reflex usually precipitated by brushing hair, eating or
• Decreased lacrimation cold drafts
• Inability to close eyes • Pain is felt on the lips, chin, teeth
• Painful eye sensations
• Photophobia Objective

Diagnostic Evaluation • Sudden closure of the eye

• Twitching of mouth or check
• Physical exam - test cranial nerve functions and
corneal sensation Management:

• Exclusion of lesions that may mimic Bell's Palsy • Anticonvulsants

• Injection of alcohol into the ganglion to relieve
• Electrophysiologic tests pain for several months or years until nerve
regenerates
(LOSS SENSATION OF CRANIAL NERVE VII) • Carbamazepine (Tegretol)
• Percutaneous radiofrequency thermorhizotomy
Management
Surgery:
• Corticosteroids
• Eye care - artificial tears, eye ointment, etc. • Cutting of the sensory root of the nerve to cause
• Physical therapy loss of sensation in the area supplied by the
• Biofeedback nerve
• NSAID's • Microscopic relocation of arterial loop that may
• Surgery - cause vascular compression of trigeminal nerve.

Anastomosis of facial nerve to other cranial nerve Acoustic Neuroma (Cranial nerve VIII)

Tarsorrhaphy - surgical closure of the eyes to protect • Lesion that forms in the inner ear that may
the cornea extend through the temporal bone.
• An acoustic neuroma is a benign tumor of
Complications cranial nerve VIII
• Common in women between 30 - 60 years old
• Corneal Ulceration
• Impaired vision Pathophysiology
• Severe body image disturbance - severe
depression • The tumor arises from the neurilemmal sheath
(Schwann sheath) along the vestibular branch of
is a chronic neuropathic disorder characterized by the vestibulocochlear nerve
episodes of intense pain in the face, originating from • The tumor spreads to the cochlear branch
the trigeminal nerve. • The tumor can compress the facial nerve, the
arteries or extend intracranially
• stabbing
• Agonizing Manifestations:

The clinical association between TN and hemi facial • Tinnitus

spasm is the so-called tic douloureux
• It has been described as among the most painful
conditions known to mankind
• Vertigo
• Progressive hearing loss (unilateral) especially
to high-pitched sounds
• If facial nerve is involved, additional symptoms
will emerge like facial muscle weakness,
drooping of eyelid, diminished taste
Management:
Other approaches:
• Surgical removal of the tumor
• However, if tumor is large (>2cm), hearing loss • Physical therapy
may compromise and be may already not • Range of motion
restored even after the surgery • Resistive exercises
• Peripheral Nerve Trauma • Splinting
• Brace support
Commonly associated with:
• athletic injuries ○ Occupational Therapy

• vehicular accidents Brain Tumor

• mechanical and equipment injuries
• falls • A primary brain tumor is one that originates in
• acts of violence the brain

Chronic nerve compression and entrapment can also • Not all primary brain tumors are cancerous
result in nerve damage.
• Benign tumors are not aggressive and normally
The peripheral nerves can regenerate after an injury do not spread to surrounding tissues, although
if conditions are favorable but clinical application is they can be serious and even life threatening.
limited
Gliomas and Astrocytic tumors
The mechanism of injury includes:
• Most common types of adult brain tumors
• partial or complete transection
• Contusion • These tumors form from astrocytes and other
• Compression types of glial cell, which are cells that help keep
• Ischemia nerves healthy (Supporting cell)
• stretch trauma
• avulsion • Some tumors may also grow from the meninges
• electrical or thermal burns (less common)

Manifestations: Clinical Manifestations:

Depends on the location of the trauma and specific
functions of the involved nerve/s. • Headaches
• Seizures
• Alterations can be motor or sensory • Changes in speech, hearing, or vision
• Balance problems
Motor • Numbness or tingling in the arms or legs
• Problems with memory
• Flaccid paralysis • Personality changes
• Muscle wasting • weakness in one part of the body

Sensory Management

• Pain • Surgical removal

• Burning sensation • Chemotherapy
• Numbness • Radiation therapy
o Gamma Knife therapy - a form highly
Autonomic changes may also be present focused radiation therapy

Management: Peripheral Nerve Trauma

• Microsurgical repair
• Decompression and repair procedures
• Successfully realigned nerves re-myelinate and
re-grow to nearly their former size
• 80% of their conduction velocity may be
regained