Spinal Cord Injury 1

What are the epidemiologic factors relevant to a 70 year old man who fell and sustained an incomplete C4 injury?
• Average age of onset of SCI has been increasing
• Most common cause of SCI is MVA (50%), but rate for falls has been progressively increasing, rate for sports is decreasing
• Increasing percentage of cervical injuries

What are common causes of nontraumatic SCI in a 30 year old woman with subacute onset of paraplegia with a T6 sensory level?
• Nontraumatic SCI more likely to be incomplete and less likely to have spasticity, DVT, autonomic dysreflexia
• DDx: MS, degenerative CNS diseases, neoplasm, vascular disease, inflammatory disease, spinal stenosis, spinal cord tumors, epidural abscess, epidural hematoma
• Transverse myelitis: can be primary or secondary to vasculitis or rheum d/o, more common in females
• Radiation myelopathy can occur months after treatment

What are the epidemiologic factors related to a girl born with L2 spinal bifida?
• Spina bifida has decreased due to folic acid
• Most common is myelomeningocele: neural elements exposed, complete neurologic deficits --> closure within 24 hours
• Meningocele: dural sac exposed, neural elements may be intact
• Occult spina bifida: closed spinal deficits including lipoma, tethered cord --> should be investigated
• Hydrocephalus seen in 90% of patients with myelomeningocele --> most require VP shunt --> underlying Chiari II malformation
• Hydrosyringomyelia (syrinx) are common in myelomeningocele --> presents with cervical pain, new weakness, spasticity, and scoliosis (can also be a sign of tethered cord)
• Scoliosis affects people with myelomeningocele at thoracic levels --> monitor curvature less than 25 degrees, greater may require TLSO or surgery