Spinal Cord and Peripheral Nervous Disorders

Spinal Cord Injury

Any damage to the spinal cord, either through trauma or degenerative disease. Clinical manifestation depends on the level of injury

Low Back Pain

Often results from muscle strain, ligament injury, degenerative disc disease or herniation, or spinal stenosis. These factors can cause mechanical pressure on spinal nerves

Clinical Manifestation of Nerve Pain

Localized or radiating pain, stiffness, limited mobility, muscle  spasms, and difficulty with ambulation. Sciatica may occur with nerve root compression

What are non-pharmacological interventions for lower back pain?

Physical therapy, stretching and strengthening, heat, TENS, acupuncture, meditation, and yoga

What are pharmacological interventions for lower back pain?

NSAIDs, acetaminophen, muscle relaxants, opioids, corticosteroids, antiseizure drugs, and antidepressants

What are surgical interventions for back pain?

Spinal fusion and discectomy

Degenerative Disc

A normal part of aging UNLESS painful. Loss of fluid in the discs between the vertebrae, causing a loss of elasticity, decreased flexibility and shock absorbing abilities. Can progress to a herniated disc 

Herniated Disc

When the disc bulges between the vertebrae. Can press against spinal nerves causing a “pinched nerve”, which can cause numbness and tingling.

Cauda Equina

Bundle of nerves at the end of the spinal cord that provides movement and sensation to the lower body

Cauda Equina Syndrome (CES)

The nerves in the cauda equina are compressed, rare but serious condition that requires immediate surgery to prevent permanent nerve and muscle damage

What are the symptoms of CES?

Weakness or numbness in the legs, genital area, anus, or buttocks (saddle anesthesia), difficulty urinating or controlling urination and/or bowel movements, and loss of sexual sensation

Spinal Cord Injury (SCI)

Results from trauma that damages the spinal cord, leading to partial or complete loss of motor, sensory, and autonomic function below the injury site

Complete SCI

Total loss of motor and sensory function below the injury level

Incomplete SCI

Varying degrees of motor and sensory loss

What happens in SCIs higher than C4?

Paralysis of respiratory muscles and all four extremities

Autonomic Dysreflexia

A potentially life-threatening condition that occurs in people with spinal cord injuries, typically at or above T6. It is caused by an overreaction of the autonomic nervous system to a stimulus below the level of injury. This can lead to a dangerous increase in blood pressure leading to stroke. 

What are the triggers for autonomic dysreflexia?

Full bladder, full bowel, and skin irritation

What are signs and symptoms of autonomic dysreflexia?

Sudden, severe headache, flushed face, hypertension, breadycardia, sweating, cold, pale skin

What should the nurse do if there are “crusts” on the patients pins?

Leave them! They serve as a natural barrier

Myasthenia Gravis

Chronic autoimmune disorder that affects nerve cell communication with muscles. The body produces antibodies that attack acetylcholine receptors on the muscle necessary for muscle contraction

What are symptoms of Myasthenia Gravis?

Muscle weakness, drooping eyelids, double vision, difficulty speaking, swallowing, and chewing, and difficulty performing repetitive movements

Fatiguability

Muscle weakness worsens with repetitive use, typically improving after periods of rest. Symptoms can fluctuate throughout the day, often worsening in the evening

Myasthenic Crisis

A severe life threatening exacerbation of muscle weakness that can involve respiratory failure due to diaphragm weakness. May be triggered by infection, stress, surgery, or inadequate medication

What are the diagnostic tests that can be done for myasthenia gravis?

Acetylcholine Receptor Antibody Test, Electromyography, Tensilon Test, and Chest Ct or MRI

Acetylcholine Receptor Antibody Test

Measures the presence of anti-acetylcholine receptor antibodies, elevated in most myasthenia gravis patients

Electromyography (EMG)

Evaluates electrical activity of muscles, reveals muscle weakness and abnormal fatiguability. Needles are stuck into the muscle to see if the muscle moves when electrical current is instilled

Tensilon Test

Short-acting acetylcholinesterase inhibitor is administered to temporarily improve muscle strength, confirming myasthenia gravis

Guillain-Barre Syndrome (GBS)

An acute, autoimmune disorder in which the body’s immune system attacks the peripheral nervous system, leading to inflammation and demyelination of the nerves. Results in impaired signal transmission, primarily affecting motor function but can also involve sensory and autonomic nerves.

What is the cause of GBS?

The exact cause is unknown, but is often triggered by a preceding infection, such as a respiratory illness, gastrointestinal illness, or a viral infection

What is the hallmark symptom of GBS?

Ascending paralysis that starts in the feet/legs and travels upwards

Lumbar Puncture for GBS

Increased protein levels with a normal white blood cell count is a key inidcator

What will be absent in patients with GBS?

Deep tendon reflexes

Trigeminal Neuralgia

Sudden, unilateral, severe, brief, stabbing, recurrent pain in the distribution of one or more branches of the trigeminal nerve. Etiology is unknown. May be due to vascular compression, tumor, structural abnormality of the skull base, or MS

What might trigger Trigeminal Neuralgia?

Chewing, talking, smiling, brushing teeth, or even a light breeze. Fear of triggering the pain can cause the patient to avoid these activities

Bell’s Palsy

An acute, unilateral paralysis or weakness of the facial muscles due to inflammation or compression of the Facial Nerve. Inflammation of the facial nerve leads to interruption of nerve signals, exact cause is unknown, but often associated with viral infections

How does Bell’s Palsy present?

Sudden onset (usually about 48 hours) of facial drooping, inability to close the eye on the effected side, smile or raise eyebrow, difficulty with speaking or eating, excessive tearing or dry eye

What are the recovery expectations for Bell’s Palsy?

Most patients see improvement within weeks to months, but some may experience residual weakness. Recovery is usually favorable, but full recovery may take time