Clinical Correlates exam three

Mild TBI

- Concussion - Symptoms appear at the time of injury or soon after - Tend to be temporary

Saccular or Berry Aneurysm

-Most frequent cause of significant subarachnoid hemorrhage •Most common cause of intracranial aneurysm •90% found near major arterial branch points in the anterior circulation •Congenital? ..... Not present at birth but develops over time due to a defect in the media of the vessel •Rupture occur more often in women in their 5th decade •May occur at any time but often are associated with straining at stool or sexual orgasm •Predisposing factors: - Cigarette smoking - HTN

Severe hyperextension of head and neck (whiplash)

AKA whiplash Can occur in a rear-end motor vehicle accident, in these cases the anterior longitudinal ligament is stretched or torn.

Excessive thoracic kyphosis "humpback or hunchback"

Abnormal increase in thoracic curvature, in which vertebral column curves posteriorly. This can occur due to erosion (due to osteoporosis) of an ant part of the vertebrae. In elderly women known as "Dowager's Hump" Loss of height and increase in AP diameter of thorax causes reduced pulmonary capacity.

Severe hyperextension of head and neck leading to Facet jumping

Another is injury can occur as the head "rebounds" back from hyperextension, snapping the head forward onto the thorax. "Facet Jumping" or locking of the cervical vertebrae can occur because of the dislocation of vertebral arches.

Fracture and Dislocation of Atlas

Atlas fracture are rare, comprise: 25% of atlantoaxial bony fracture 10% of cervical spine injuries 2% of all spinal injuries - The mechanism of injury includes: • Hyperextension • Lateral compression • Axial compression Vertical forces can compress the lateral masses between the occipital condyles and the axis which can then drive them apart fracturing one or both of the anterior or posterior arches. Diving in shallow water and motor vehicle accidents (being thrown up against the roof) are the major causes of the atlas fractures. They are called Jefferson Fractures and the fracture in itself does not necessarily result in spinal cord injury because the dimensions of the bony ring actually increase If spinal cord injury is present it indicates a rupture of the transverse ligament. The principal treatment is with a halo and vest or cast, which remains an effective current treatment for many of these fractures.

Sudden forceful extension of the neck

Can occur by head butting or illegal face blocking in football. This can fracture/crush or compress posterior parts of the vertebrae such as the vertebral arches and their processes. This can radiate pain to the back of the neck and scapular region because of the spinal sensory ganglia and spinal cord segments.

Sudden forceful flexion of the head and neck

Can occur during automobile accidents or from a violent blow to the back of the head. Results in a crush or compression of the body of one or more vertebrae. If anterior movement of vertebrae occurs in combination of compression, the vertebra can displace anteriorly on the vertebrae inferior to it (dislocation of C6 or C7). Usually this displacement dislocates and fractures the articular facets between the two vertebrae and ruptures the interspinous ligaments. Irreparable spinal cord injuries accompany most severe flexion injuries.

Spondylolisthesus of L5

Can occur from failure of L5 centrum to unite with neural arches at neurocentral joint during development. Spondylolisthesis at the L5-S1 joint may result in pressure on the spinal nerves of the Cauda equina as they pass to the superior part of the sacrum causing lower back pain and lower limb pain.

Contrecoup injury

Caused when the brain bounces off the its surface and impacts against the opposing side of the skull.

Coup injury

Caused when the head is stopped suddenly and the brain rushes forward - The brain gets injured by hitting the side of skull and also by rubbing against its inner ridges

Excessive Lumbar Lordosis "Hollow back or Swayback"

Characterized by anterior tilting of the pelvis (upper sacrum flexed and rotated) with increased extension of lumbar vertebrae. Associated with weak trunk musculature, especially in abdominal muscles. Can occur during late pregnancy causing lower back pain. Can also occur with obesity ( ex. Potbelly) disrupting line of gravity.

Parkinson's disease

Characterized by bradykinesia or akinesia, rigidity, and resting tremor of the hands and fingers Caused by loss of dopaminergic neurons in the substantia nigra

Huntington's disease

Characterized by choreiform movements: involuntary, continuous movement of the body, especially of the extremities and face. • Results from the selective loss of striatal neurons • Genetic condition (50%)

Kyphoscoliosis

Combined scoliosis with excessive thoracic kyphosis having an abnormal AP diameter and leading to restriction of lung and thorax expansion.

Vertebral body osteoporosis

Common metabolic bone disease often detected during radiographic studies. demineralization of bones causes CA deposit/reabsorbtion disruption resulting in reduced bone mass and atrophy of skeletal tissue. Can especially affect the horizontal trabeculae of vertebral body. Most common in thoracic vertebrae, especially pre-menopausal females.

Scoliosis

Crookedness or curved back characterized by abnormal lateral curvature that is joined by rotation of vertebrae. - spinous processes rotate towards abnormal curvature - when bending over ribs rotate posteriorly and protrude to side with inc convexity. - can cause hemivertebra (failure of the half of the vertebra to develop) -when its entirely postural it disappears during max. flexion of vertebral column.

Fractures of Calvaria

Depressed fractures - Occur in the thin areas of the calvaria - A bone fragment is depressed inward, compressing and/or injuring the brain Contrecoup fracture - The fracture occurs at the opposite side of impact Linear calvarial fractures - Most frequent - Occur at the point of impact - The fracture lines radiate in two or more directions Comminuted fractures - The bone is broken in several pieces

Dislocation of cervical vertebrae

Due to orientation of horizontal orientation of articular facets, the CV are less tightly interlocked. Slight dislocation- can occur at the large vertebral canal in the cervical region without damaging the spinal cord. Severe dislocations combined with fractures can injure the spinal cord. If the displacement does not result in "facet jumping" with locking

Myopathic scoliosis

Extrinsic structural vertebra problems that lead to asymmetrical weakness of intrinsic back muscles.

Ischemia of the spinal cord

Fractures, dislocations, as well as those combined that interfere with the blood supply to the spinal cord from the spinal and medullary arteries. Ischemia can lead to muscle weakness and paralysis Obstructive arterial disease can narrow the anterior segmental medullary artery in particular, causing circulatory impairment. Also with a severe blood pressure drop of 3-6 min, segmental medullary and anterior spinal artery can be reduced or stopped causing loss of sensation and voluntary movements in the mid-thoracic region.

LeFort III fracture

Horizontal fracture Passes through the superior orbital fissure, ethmoid and nasal bones, and laterally to the greater wings of the sphenoid

Back Sprain

Injury in which only ligamentous tissue, or the attachment of ligament to bone is involved without dislocation or fracture - Due to excessive extension or rotation - Common injury in sports - Some degree of tearing of muscle fibers - Often involved are muscles producing movements of lumbar IV joints especially the erector spinae muscles

Coccydynia

Injury of Coccyx -with possible causes of Fall with- • Bruising of coccyx • Fracture of coccyx • Dislocation of the sacrococcygeal joint Childbirth

Bell Palsy

Injury to facial nerve (CN VII) or its branches on the affected side - Sxs: sagging skin, distorted facial expression, evertion of inferior eyelid, impaired speech - Paralysis of buccinator and/or orbicularis oris will cause food to accumulate in the mouth

Fracture of the Dens Axis

Make up 40% of the fractures of the axis. Fracture of the dens are also common axis injuries that result from a horizontal blow to the head or from osteopenia(loss of bone mass) The most common dens fracture occurs at its base at its junction with the body of the axis. Often these fragments do not reunite because transverse ligament of the atlas becomes interposed between fragments. As a result of separated fragment, this results in lack of blood supply, resulting in avascular necrosis. Other dens fractures occur due to abnormal ossification patterns.

Injury to T11 and T12 vertebrae

Most common injured non-cervical vertebrae T11 and T12 which participate in rotatory movements superiorly but only flexion and extension movements inferiorly Usually uncommon because of the interlocking of their articular processes. However when spondylosis (fracture of the column of bones connecting super./infer. articular processes known as the "pars interarticularis" occurs , the interlocking mechanism is broken.

Hyperextension of head and neck..Hangman's Fracture or Fracture and Dislocation of Axis

One of the most common injuries of the cervical vertebrae. Fracture of the vertebral arch of the axis at the pars interarticularis (the bony column formed by superior and inferior articular processes of the axis) Fracture in this location known as cervical spondylolysis of C2. Method of capital punishment by hanging. In more severe injuries, if C2 vertebrae is displaced anteriorly over the body of C3 injury to the spinal cord and/or brainstem is to be expected causing quadriplegia.

Back Pain- nervous tissue: spinal nerves or nerve roots exiting the IV Formina

Pain caused by compression or irritation of spinal nerves or nerve roots is typically known as "referred pain" coming from cutaneous or subcutaneous areas (dermatome) supplied from that nerve.

Herniation of the Nucleus Pulposus

Refers to the protrusion of the gelatinous nucleus into or through the anulus fibrosus. Causes lower back pain (LBP) and lower limb pain - Extends posterolaterally where the anulus fibrosus is thin Causes two types of pain Acute pain or localized pain-Pressure on the posterior longitudinal ligament. Chronic pain or referred pain- Posterolateral herniation past the ligament that causes compression of the spinal nerve roots associated with sciatic with the affected nerve roots of L5-S1

Transsection of the Spinal cord

Results in all loss of sensation and voluntary movement below the lesion. (C1-C3)- No func. below head level, ventilator required for respiration (C4-C5)- Quadriplegia- No func. of upper and lower limbs, respiration occurs (C6-C8)- Loss of lower limb function combined with loss of hand and some upper limb. May be able to self feed and use wheelchair (T1-T9)- Paraplegia- Paralysis of both lower limbs and trunk control will vary with height of lesion (T10-L1)- Some thigh muscle function, may allow walking with long leg braces (L2-L3- retention of most leg function, short leg braces may be required for walking)

Habit scoliosis

Standing or sitting in an improper position

Muscle Spasm

Sudden involuntary contraction of one or more muscle groups - Protective mechanism after an injury or inflammation of back musculature - Sxs: cramps, pain, involuntary movement, distortion.

LeFort I fracture

Transverse fracture of the maxilla Above the teeth through the nasal septum, palatine and sphenoid bone

Severe TBI

Unconscious for more than 24 hours Research has linked moderate to severe TMI to a greater risk (2.3x) of developing Alzheimer's and other dementias - Seen in athletes, boxers, etc. - Fencing response

Moderate TBI

Unconsciousness that last more than 30 minutes

Back Pain-Synovial joints: Zygapophysial AKA facet joints

associated with aging (osteoarthritis) or with disease (rheumatoid arthritis of joints) The sharp pain from a dislocation is ligamentous.

Functional scoliosis

difference in length of lower limbs with a compensatory pelvic tilt.

Back Pain- Muscles (intrinsic muscles of back)

localized lower back pain (LBP) is typically muscular or fibroskeletal. Muscle pain is usually related to reflexive cramping (muscle spasms) producing ischemia which is secondary to guarding in anticipatory pain.

Back Pain- Fibroskeletal structures: periosteum, ligaments, and annuli fibrosi of IV ligaments

localized lower back pain (LBP) is typically muscular or fibroskeletal. The sharp pain following a fracture is mostly in periosteal origin. Acute localized pain is associated with an IV disk herniation which is the nucleus pulposus causing impingement on the posterior longitudinal ligament.

LeFort II fracture

"Pyramidal" fracture Passes from the posterolateral parts of the maxillary sinuses through the orbital floor, across nasal bones and septum

Traumatic Brain Injury (TBI)

•Is the result of direct impact to the head that disrupts normal brain function •Classified as: mild, moderate and severe •Depend on unconsciousness, how long it lasts, and symptom severity •Even those considered mild TBI can cause serious and long lasting effects