Spinal cord trauma

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• is associated with a complex array of symptoms and signs depending on the level and severity of the injury

• In general, significant spinal cord trauma results in initial loss of somatic and autonomic nerve function called spinal shock.

• spinal shock stage usually resolves in one to three weeks at which time, the injured individual moves into a heightened reflex activity stage where the spinal reflexes return resulting in a changing clinical picture.

 

• Spinal Shock Stage
Spinal shock is characterized by the following symptoms below the level of the lesion:

• Flaccid paralysis

• Loss of sensation

• Hypothermia

During this period the injured person also experiences:

• Loss of bladder and rectal control

• Hypotension

• in addition to spinal shock, individuals with cervical or upper thoracic cord injury may experience neurogenic shock.

• In spinal cord injury, neurogenic shock is caused by the loss of sympathetic nervous system activity, which results in loss of vascular tone below the lesion level.

• When vascular tone is lost, massive vasodilation occurs, resulting in severe hypotension.

 

Heightened Reflex Activity Stage of Spinal Cord Trauma

• After spinal shock resolves, the individual moves into a heightened reflex activity stage, whereby upper motor neuron dysfunction presents with:

• Return of bladder-emptying reflex

• Hypertonic paralysis

• Hyperreflexia

 

autonomic hyperreflexia (dysreflexia)

• A troublesome manifestation that develops in this stage.

• This syndrome results from massive, uncompensated cardiovascular responses to sympathetic nervous system discharge, including hypertension, sweating, and flushing.

• It can be stimulated by pain, touch, or often a full bladder or bowel

• can be relieved with parasympathetic stimulation such as bowel- or bladder-emptying.

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