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3 results

  • Chapter 17 - Traumatic and Nontraumatic Spinal Cord Disorders

  • from Section 3 - Specific Neurological Disorders in Emergency Medicine
  • Edited by Thomas P. Campbell, Allegheny Health Network, Pittsburgh, Kevin M. Kelly, Allegheny Health Network, Pittsburgh
  • Book:
    Handbook of Emergency Neurology
    Published online:
    10 January 2024
    Print publication:
    17 August 2023, pp 246-268

  • Summary

    Traumatic spinal cord injury requires urgent imaging and decision-making involving a team approach. Causes of nontraumatic spinal cord injury are protean and can be roughly divided into compressive and non-compressive disease states. In general, it is the scenario of compressive spinal injury that needs to be identified quickly for possible urgent surgical decompression, whereas non-compressive injury requires a systematic work-up, which is somewhat less urgent. MRI is the imaging modality of choice for essentially all acute spinal cord disorders presenting to the ED, and the physician is charged with expeditious performance of this testing whenever spinal cord compression is deemed a likely possibility.

  • 31 - Chronic obstructive pulmonary disease

  • from Section 5 - Respiratory emergencies
  • Edited by Kaushal Shah, Jarone Lee, Kamal Medlej, American University of Beirut, Scott D. Weingart
  • Book:
    Practical Emergency Resuscitation and Critical Care
    Published online:
    05 November 2013
    Print publication:
    24 October 2013, pp 208-212

  • Summary

    This chapter discusses the diagnosis, evaluation and management of acute spinal cord compression. It presents special circumstances which make diagnosis and management of Cauda equina syndrome difficult. Spinal shock is characterized by a loss of spinal cord function below the level of the lesion. Cervical and thoracic level lesions may be associated with respiratory compromise. The spinal shock results in a disruption of sympathetic innervation causing unopposed parasympathetic tone, which may also cause hypotension and bradyarrhythmias (neurogenic shock). The spinal shock is characterized by flaccid paralysis and loss of bladder/bowel control. The diagnosis of acute spinal cord compression is suggested by history and physical examination, and confirmed by radiography or surgical intervention. Clinical presentations may vary depending on the level of neurological injury. The most likely causes for sudden decompensation in spinal cord include expansion of the ending lesion causing worsening neurological compromise or a high cervical/thoracic lesion.

  • 29 - Spinal Cord Injury

  • from SECTION IV - NEUROLOGICAL TRAUMA
    • By Charles H. Bill, Sparrow Healthcare System Lansing, Michigan, Vanessa L. Harkins, Sparrow Helthcare System Sparrow Hospital/MSU Emergency Medicine residency Program Lansing, Michigan
  • Edited by Sid M. Shah, Michigan State University, Kevin M. Kelly, Drexel University, Philadelphia
  • Book:
    Principles and Practice of Emergency Neurology
    Published online:
    06 August 2009
    Print publication:
    18 February 2003, pp 286-303

  • Summary

    Spinal cord injuries at or above the C4 level can result in respiratory compromise. When the level of injury is just below the origins of the phrenic nerves, intercostal muscle function is lost, and the patient can be completely dependent on diaphragmatic contraction for respiration. Various degrees of transient neurological disability may occur as a result of a phenomenon known as spinal shock. Spinal shock results from physiological transection of the spinal cord, which commonly lasts 24-48 hours. Acute cervical strain is the most common injury following a vehicular accident. Injuries to the carotid and vertebral arteries and jugular veins are commonly associated with spinal cord injuries caused by gun shot wounds. The Third National Acute Spinal Cord Injury Randomized Controlled Trial (NASCIS III) concluded that high-dose methylprednisolone administration is associated with improved neurological outcome in spinal cord-injured patients. Spinal cord injuries are rare in patients under 17 years old.