Herein we present a case in which a paraplegic spina bifida patient presenting with symptomatic spinal retethering experienced autonomic dysreflexia following an elective spinal cord transection. [ncbi.nlm.nih.gov]

Cord injury usually follows breech presentation, the lesion is in the lower cervical or upper thoracic segments, and results from excessive traction. [adc.bmj.com]

A 53-year-old man presented to the emergency department with a glasgow coma scale score of 15 after sustaining a stab wound to the posterior neck. At presentation, he was unable to move his legs and he was unable to feel from the chest downward. [onlinejets.org]

• Unable to Stand

  Review Questions: Case 3Following surgical repair of a knife wound the patient is unable to stand or walk becausehe is unable to move or bear weight on his right leg. [slideshare.net]

• Fecal Incontinence

  Fecal incontinence Hypotonic anal sphincter Abnormal bulbocavernosus and anal wink reflexes Transverse myelopathy Lesions affecting all or most tracts of the spinal cord at ≥ 1 segmental levels Deficits in all functions mediated by the spinal cord (because [merckmanuals.com]

  Fecal incontinence is common. Stool softeners, mini-enemas, and digital stool removal may keep the rectum empty, reducing incontinence frequency. [americannursetoday.com]

• Diarrhea

  This may help prevent diarrhea. Drink several glasses of water each day. This can prevent constipation. Medications. [webmd.com]

  Your healthcare provider might advise you to call them if you have problems such as: Skin sores or infections Trouble breathing Fever, cough, or other signs of infection Severe headache Not urinating regularly or having severe diarrhea or constipation [hopkinsmedicine.org]

• Sweating

  The spasms may be associated with sweating, emptying of the bowel and bladder, flushing and raised blood pressure. This phase can last for up to 12 months, after which the heightened reflexes fade. [wisegeekhealth.com]

  Patients requiring vasopressors should be managed in PICU Temperature The loss of temperature control e.g. ability to sweat, shiver, vasodilate, vasoconstrict or position self to maintain temperature. [rch.org.au]

  One or more common symptoms that often occur with the high blood pressure are a severe headache, sweating, flushing, goose bumps, chills, a feeling of anxiety, and a slower pulse rate. [nafc.org]

  The resultant catecholamine release and vasoconstriction lead to hypertension associated with headache, bradycardia, tachycardia, cardiac arrhythmia, sweating, flushing, tingling, nasal congestion, piloerection, and, occasionally, respiratory distress [acog.org]

  Spinal cord dysfunction causes Paresis Loss of sensation Reflex changes Autonomic dysfunction (eg, bowel, bladder, and erectile dysfunction; loss of sweating) Dysfunction may be partial (incomplete). [merckmanuals.com]

• Back Pain

  Symptoms Patients with associated spine fractures typically have significant, localized neck or back pain. Patients with incomplete spinal cord injuries may complain of pain in other areas and not notice the severity of neck of back pain. [uscspine.com]

  However, less than 0.1% of people with back pain who visit their general practitioner have spinal metastases [ 3 ]. [patient.info]

  It can cause low back pain, weakness or paralysis in the lower limbs, loss of sensation, bowel and bladder dysfunction, and loss of reflexes. Unlike in conus medullaris syndrome, symptoms often occur on only one side of the body. [en.wikipedia.org]

• Muscle Spasticity

  spasticity (increased muscle tone) management Medications and alternative methods of managing pain and spasticity Psychological counseling Identifying problems and solutions for thinking, behavioral, and emotional issues Family support Assistance with [urmc.rochester.edu]

  Spasticity can reduce venous pooling and stabilize the thoracic and abdominal muscles used in respiration. [americannursetoday.com]

• Hyperreflexia

  It presents with spastic paresis, hyperreflexia, and continued sensory loss. Acute stabilization, a thorough neurological examination, and imaging is required for adequate diagnosis. [amboss.com]

  When the stage of spinal shock passes, the typical UMN picture within hyperreflexia and spastic paralysis below the level of the injury supervenes. Clinical symptoms and signs of spinal cord transection depend on the level injured. [casemed.case.edu]

  Ipsilaterally, paralysis, loss of vibration and position sense below the level of the lesion, hyperreflexia, and an extensor toe sign are present. In addition, ipsilateral segmental anesthesia occurs at the level of the lesion. [emedicine.medscape.com]

  After days or weeks, upper motor neuron dysfunction evolves into spastic paresis (increased muscle tone, hyperreflexia, and clonus). Extensor plantar responses and autonomic dysfunction are present. [merckmanuals.com]

• Spastic Paralysis

  Characteristically there is: lower motor neuron paralysis at the level of injury upper motor neuron (or spastic) paralysis below the level of injury The degree of neurological compromise corresponds with the degree of cord transection. [radiopaedia.org]

  A change in symptoms occurs after a period of 6–8 weeks and includes spastic paralysis, recurrence of proprioceptive reflexes as hyperreflexia, and the presence of pathological reflexes (e.g., plantar reflex )! References: [1] [2] [3] [4] [amboss.com]

  When the stage of spinal shock passes, the typical UMN picture within hyperreflexia and spastic paralysis below the level of the injury supervenes. Clinical symptoms and signs of spinal cord transection depend on the level injured. [casemed.case.edu]

• Flaccid Paralysis

  It presents as a flaccid areflexic paralysis below the level of the injury with autonomic features (e.g., hypotension and bradycardia ). After some days to weeks the spinal shock wears off and a complete spinal cord injury may remain. [amboss.com]

  During this period, there is complete absence of reflex and autonomic activity below the level of the injury with flaccid paralysis. [casemed.case.edu]

  Incomplete deficit E Normal Normal Motor Normal Sensory Acute Phase Conditions Neurogenic shock Spinal shock defined as temporary loss of spinal cord function and reflex activity below the level of a spinal cord injury. characterized by flaccid areflexic [orthobullets.com]

  Signs & symptoms of acute SCI Flaccid paralysis below level of injury Loss of spinal reflexes below level of injury Loss of sensation (pain, touch, proprioception, temperature) below level of injury Loss of sweating below level of injury Loss of sphincter [rch.org.au]

• Spastic Paraplegia

  Google Scholar [3] Behan W.M.H., Maia M. : Strumpell's familial spastic paraplegia: genetics and neuropathology. J. Neurol. Neurosurg. Psychiatry 37:8–20, 1974. [link.springer.com]

  7347432 Clinical observations on patients with spastic paraplegia have indicated that a training regime including weight load on the lower limbs may reduce the muscular hypertonus. [easystand.com]

• Incontinence

  Treatments for Bowel Incontinence Bowel incontinence is usually treatable. In many cases, it can be cured completely. Recommended treatments vary according to the cause of bowel incontinence. [webmd.com]

  […] control (incontinence), increase bladder storage, or empty the bladder. [nafc.org]

  No effect of SC-transection was found on incontinence severity, clean intermittent catheterization frequency, use of antimuscarinic drugs, or signs of renal damage on ultrasound. [ncbi.nlm.nih.gov]

  Fecal incontinence Hypotonic anal sphincter Abnormal bulbocavernosus and anal wink reflexes Transverse myelopathy Lesions affecting all or most tracts of the spinal cord at ≥ 1 segmental levels Deficits in all functions mediated by the spinal cord (because [merckmanuals.com]

  Fecal incontinence is common. Stool softeners, mini-enemas, and digital stool removal may keep the rectum empty, reducing incontinence frequency. [americannursetoday.com]

• Urinary Retention

  However, it mimics conus medullaris syndrome, causing distal leg paresis and sensory loss in and around the perineum and anus (saddle anesthesia), as well as bladder, bowel, and pudendal dysfunction (eg, urinary retention, urinary frequency, urinary or [merckmanuals.com]

  During the initial stage of spinal shock after cord transection at any level, reflex emptying of the bladder may be lost, resulting in urinary retention and bladder distention. [casemed.case.edu]

  In lower thoracic and lumbar/sacral cord lesions, hypotension is not present but urinary and bowel retention are. [emedicine.medscape.com]

  The latter can lead to neurogenic shock, paralytic ileus, aspiration, urinary retention, priapism and loss of thermoregulation. Clinical features depend upon the extent and rate of development of cord compression. [patient.info]

  Genitourinary management A patient in neurogenic shock experiences abrupt loss of voluntary muscle control and reflexes, resulting in acute urinary retention. [americannursetoday.com]

• Urinary Incontinence

  Male Stress Urinary Incontinence surgery Female Stress Urinary Incontinence PHARMACEUTICAL TREATMENT Your doctor may prescribe medications to improve bladder function, such as reduce bladder contractions, lower urinary frequency, improve loss of bladder [nafc.org]

  It is common to experience sexual dysfunction after injury, as well as dysfunction of the bowel and bladder, including fecal and urinary incontinence. [9] It is also possible for the bladder to fail to empty, leading to a potentially harmful buildup of [en.wikipedia.org]

Adult Sprague-Dawley rats (n=56) transected at T8-9 had one of five treatments beginning 7 days after transection: Tx (transection only), Tx+Ex, Tx+DOPA, Tx+Ex+DOPA, and control (Ctl, no treatment) groups. [ncbi.nlm.nih.gov]

It should be a focus of treatment strategies. [books.google.de]

Combinatorial treatment generated motor axon regeneration beyond both C5 hemisection and T3 complete transection sites. [jneurosci.org]

Often, more than one treatment method may be required to control symptoms. Nonsurgical treatments are often recommended as initial treatment for bowel incontinence. These include: Diet. [webmd.com]

Treatment and prognosis The role of acute MRI is usually to assess for the presence of treatable acute pathologies such as an epidural hematoma or cord compression, which can be targeted by surgical decompression. [radiopaedia.org]

Disease monographs include definition, incidence and prevalence, etiology, laboratory results, clinical manifestations, treatment, anesthetic considerations, and prognosis. [books.google.com]

Prognosis The spinal cord has very limited powers of regeneration. Prognosis for neurological deficit depends on the magnitude of the spinal cord damage present at the onset. [patient.info]

According to the National Institutes of Health (NIH), the prognosis of spinal cord damage will depend on if the injury was complete or incomplete. [birthinjuryguide.org]

Glasis Post 1 Unfortunately at this time spinal cord injuries mean a pretty gloomy prognosis. An injury to the spinal cord generally results in some sort of permanent impairment regardless of the treatment. [wisegeekhealth.com]

Disease monographs include definition, incidence and prevalence, etiology, laboratory results, clinical manifestations, treatment, anesthetic considerations, and prognosis. [books.google.com]

References: [1] [2] [3] Complete spinal cord injury Etiology Incomplete spinal cord syndromes may develop into complete spinal cord lesions Trauma (complete transection) Spinal tumors, multiple sclerosis, or myelitis Extradural pathologies (e.g., spinal [amboss.com]

The most common etiologies include trauma ; compression from tumor, hematoma, or abscess ; or transverse myelitis (viral, post-viral, or demyelinative), among other causes. [casemed.case.edu]

Wilder BL : Hypothesis: The etiology of midcervical quadriplegia after operation with patient in the sitting position. Neurosurgery 1982; 11 : 530 -531. 7. [neurologyindia.com]

He has since completed further training in emergency medicine, clinical toxicology, clinical epidemiology and health professional education. [lifeinthefastlane.com]

Epidemiology, demographics, and pathophysiology of acute spinal cord injury. Spine 2001;26S:2. Tator CH, Duncan EG, Edmonds VE, et al. Changes in epidemiology of acute spinal cord injury from 1947 to 1981. Surg Neurol 1993;40:207. [uscspine.com]

Clinical Epidemiology. 6 : 309–31. doi : 10.2147/CLEP.S68889. PMC 4179833. PMID 25278785. ^ Devivo MJ (May 2012). "Epidemiology of traumatic spinal cord injury: trends and future implications". Spinal Cord. 50 (5): 365–72. doi : 10.1038/sc.2011.178. [en.wikipedia.org]

Introduction Epidemiology incidence 11,000 new cases/year in US 34% incomplete tetraplegia central cord syndrome most common 25% complete paraplegia 22% complete tetraplegia 17% incomplete paraplegia demographics bimodal distribution young individuals [orthobullets.com]

Organized by disease, the new edition of this popular guide has been completely revised and updated to reflect the latest information on definition, current pathophysiology, significant pre-, intra-, and postoperative factors of the disease process, anesthetic [books.google.de]

Pathophysiology and pharmacologic treatment of acute spinal cord injury. Spine J 2004;4:451. Rizzolo SJ, Vacarro AR, Cotler JM: Cervical spine trauma. Spine 1994;19:2288. Sekhon LH, Fehlings MG. [uscspine.com]

Most dramatic effects noted in the first few weeks with most patients stabilizing in 7-10 days SCI pathophysiology & presentation Complete/incomplete injury A complete SCI results in loss of all motor and sensory function below the level of injury (AIS [rch.org.au]

Pathophysiology primary injury damage to neural tissue due to direct trauma irreversible secondary injury injury to adjacent tissue due to decreased perfusion lipid peroxidation free radical / cytokines cell apoptosis methylprednisone used to prevent [orthobullets.com]

"Epidemiology, demographics, and pathophysiology of acute spinal cord injury". Spine. 26 (24 Suppl): S2–12. doi : 10.1097/00007632-200112151-00002. [en.wikipedia.org]

The authors describe the case of an 11-year-old girl with lumbar myelomeningocele and worsening thoracolumbar scoliosis who underwent a T11-L5 fusion and spinal transection to prevent tethering. [ncbi.nlm.nih.gov]

With no cure for SCI available, prevention remains key. To help prevent behavior that can lead to this devastating injury, educate the public on how to prevent SCIs. [americannursetoday.com]

This may help prevent diarrhea. Drink several glasses of water each day. This can prevent constipation. Medications. [webmd.com]

The spinous process and transverse process would prevent a knife blade from crossing the midline before entering the ligamentum flavum. [onlinejets.org]