ila spinal cord injury dec 2010
TRANSCRIPT
-
8/3/2019 ILA Spinal Cord Injury Dec 2010
1/33
INTEGRATED LEARNING
ACTIVITY
ROAD TRAFFIC
ACCIDENTBy
Ihab Zidan : Neurosurgery
Gihan Younis : Physical MedicineMaysa Amer : Medical Education
With contributions of : Anatomy , Histology, Physiology , PathologyDepartments Staff
-
8/3/2019 ILA Spinal Cord Injury Dec 2010
2/33
Adel, a young 20-year old fellow
was driving his brand new car on
the desert road with a speed that
exceeded 120 Km/hr, chatting withhis friend Sherif, who was sitting
in the front seat beside him.
All of a sudden, a truck came in
the way which forced Adel to turn
the car steeply to the right trying
to avoid it. However, he couldnt
control the steering wheel and his
car turned upside down 2 times
before it stopped by the edge of
the road.
-
8/3/2019 ILA Spinal Cord Injury Dec 2010
3/33
Both friends- not fastening their seatbelts- hit
the front glass forcefully and were ejected from the
car.
When the rescuers arrived they found Sherif
screaming from agonizing neck pain and was
unable to move his right upper and lower limbs.
Meanwhile, Adel was very anxious for being
unable to move his four limbs. He also had severe
neck pain. The examining doctor suspected injury ofthe vertebral spine for both.
-
8/3/2019 ILA Spinal Cord Injury Dec 2010
4/33
Q1: What might be the injured part of vertebralspine for both of them?
Q2: Can you describe the operating forces in
this type of injury?
Q3: What could be the value of fastening the
seat belt?
-
8/3/2019 ILA Spinal Cord Injury Dec 2010
5/33
How did the rescuers transported
each of them?
-
8/3/2019 ILA Spinal Cord Injury Dec 2010
6/33
-
8/3/2019 ILA Spinal Cord Injury Dec 2010
7/33
Q4: Why did the rescuers used
this method and fixed them in
this position
-
8/3/2019 ILA Spinal Cord Injury Dec 2010
8/33
On arrival to the hospital :
Sherifs blood pressure was 60/40mmHg, pulse was
130 beat per minute
Adels blood pressure was 75/50 mmHg, pulse 124beat per min.
They were started on pain killers, Intra venous
fluids ,corticosteroids.
-
8/3/2019 ILA Spinal Cord Injury Dec 2010
9/33
Q5:What is your explanation for
hypotension ( low BP) ?
Q6: Explain how different groups
of pain killers act
-
8/3/2019 ILA Spinal Cord Injury Dec 2010
10/33
Both of them were breathing spontaneously
with normal breathing pattern.
Q7: What is the importance of
checking the breathing andensuring that the pattern is normal?
Q8: Explain why both patients werebreathing normally?
-
8/3/2019 ILA Spinal Cord Injury Dec 2010
11/33
The doctor who examined Sheriffound the following:
He was not feeling well the pricks of pin over his lower
limb, trunk, and medial aspect of upper limb and hand(including the middle finger) at the left side.
He was not feeling the touch of the cotton piece moved by
the doctor on the skin of the right side.
He was also unable to report on the movement or position of
his toes with diminished vibration sense on the right side.
He was unable to move his right lower limb at all.
The doctor found that the tone was decreased and he could
not elicit deep tendon jerks in this limb.
In the right upper limb, he was only able to flex the elbow
move the shoulder, and the hand grip was weak.
The triceps reflex was diminished with intact biceps and
brachioradialis reflexes.
Muscle power at left side of the body was normal.
Fi di N l i E i i
-
8/3/2019 ILA Spinal Cord Injury Dec 2010
12/33
Diminished
pin prick
sensation
Absence of sensation for
cotton piece all over this
side
Cannot move all lower limb
Normal musclepower
Decreased tone ,
absent tendon jerks
Moves shoulder
flex elbow
Findings on Neurologic Examination
Sherif
Cannot report movement &
position of Toes.
Lost triceps reflex
intact biceps and brachioradialisreflexes.
-
8/3/2019 ILA Spinal Cord Injury Dec 2010
13/33
This clinical picture is called the Brown Squard
syndrome and is due to hemisection of the spinalcord.
Q9: Where do you suspect the
probable spinal level of injury
would be?
-
8/3/2019 ILA Spinal Cord Injury Dec 2010
14/33
Q10- What are the structures present
at the probable site of injury?
-
8/3/2019 ILA Spinal Cord Injury Dec 2010
15/33
Q11- Label the tracts in the figure?
2
3
5
4
6
9
10
8
7
1
-
8/3/2019 ILA Spinal Cord Injury Dec 2010
16/33
Q12: Mention the anatomical pathwaysof each tract.
Q13: Deduce the functions affected
Q14: Describe the pathological
changes that happen after neural
injury.
-
8/3/2019 ILA Spinal Cord Injury Dec 2010
17/33
Q15: State the imaging studies youthink will be of help to diagnose
the site and degree of injury.
The doctor ordered some imaging studies:
-
8/3/2019 ILA Spinal Cord Injury Dec 2010
18/33
Q16 : What is this
imaging study
Q17: What do you see
in it ?
The first imaging study done is this one
-
8/3/2019 ILA Spinal Cord Injury Dec 2010
19/33
Q18: What is the type of radiological imaging in figures 1 &2 & what would be the added value of their use ?
Q19: What is the lesion seen ?
This was followed by 2 other imaging studies
Fig 1 Fig 2
-
8/3/2019 ILA Spinal Cord Injury Dec 2010
20/33
Neurologic findings for Adel
No movement in all four limbs
slight movement of the shoulder.
loss of superficial sensation ofall dermatomes of the four limbsup to shoulders
absence of the deep reflexes anddeep sensation of the 4 limbs.
M hil Th d h i d Ad l f d h
-
8/3/2019 ILA Spinal Cord Injury Dec 2010
21/33
No Movementexcept slight atthe shoulder
Meanwhile, The doctor who examined Adel found that :
loss of superficialsensation
absence of thedeep reflexes
and deepsensation
-
8/3/2019 ILA Spinal Cord Injury Dec 2010
22/33
The doctor ordered some imaging studies for Adel:
Q20: What is this type of radiological
investigation?
Q21 :What do you see in the figures?
-
8/3/2019 ILA Spinal Cord Injury Dec 2010
23/33
Q22: What is this type of radiologicalinvestigation?
Q23: What are the arrows pointing to?
-
8/3/2019 ILA Spinal Cord Injury Dec 2010
24/33
Q24: What is this type of investigation?Q25: Interpret the findings
-
8/3/2019 ILA Spinal Cord Injury Dec 2010
25/33
Diagnosis Stabilization Surgeryfor Both
Adel had Decompression and fixation usingplate and screws for C4,5
-
8/3/2019 ILA Spinal Cord Injury Dec 2010
26/33
Sherif had anterior cervical discectomy
(removal of the intervertebral disc betweenC6/ 7), with insertion of iliac bone graft, andanterior cervical fixation for C6/7 using plateand screws.
-
8/3/2019 ILA Spinal Cord Injury Dec 2010
27/33
They remained for one week in the hospital.
Progress :Sherif started to move his right lower limb;the tone in the limb began to increase
exaggeration of tendon jerkspositive Babinski sign.The power of the hand was partially resumed.
Adel showed the same picture in the four limbsbut more in the lower limbs.
-
8/3/2019 ILA Spinal Cord Injury Dec 2010
28/33
Progress
Sherif started to move his right lowerlimb;
the tone in the limb began to increaseexaggeration of tendon jerks
positive Babinski sign.
The power of the hand was partiallyresumed.
-
8/3/2019 ILA Spinal Cord Injury Dec 2010
29/33
ProgressAdel showed the same
picture in the fourlimbs but more in thelower limbs.
-
8/3/2019 ILA Spinal Cord Injury Dec 2010
30/33
Q26: What is the interpretationof the above mentioned
findings? Explain in viewof the anatomical andphysiological alterations.
-
8/3/2019 ILA Spinal Cord Injury Dec 2010
31/33
-
8/3/2019 ILA Spinal Cord Injury Dec 2010
32/33
Q24: What do you think is thevalue of these exercises?
-
8/3/2019 ILA Spinal Cord Injury Dec 2010
33/33
After 6 months of intensive physical therapy, both
showed marked improvement in their
neurological functions.