Spinal Cord / Peripheral Nervous System Disorders

Central nervous system

Responsible for processing information and coordinating the body's responses

-Brain, spinal cord, meninges (pia / arachnoid / dura mater), cerebral spinal fluid

S[inal cord anatomy and physiology

Sends and receives sensory stimuli and motor instructions, along with direct reflexes

-Extends from the medulla oblongata in brain through the vertebrae

-Conposed of white and gray matter

-Contains sensory (ASCENDING) and motor (DESCENDING) Tracks

Spinal cord segments

Parts of the spinal cord that send and receives nerve signals to different areas of the body

-Reflex arc

-Spinal nerves: 31 pairs (8 cervical, 12 thoracic, 5 lumbar, 1 coccygeal, 5 sacral)

Low back pain pathophysiology

Low-back pain often results from muscle strain, ligament injury, degenerative disc disease / herniation, or spinal stenosis

-These factors cause mechanical pressure on the spinal nerves

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

Low back pain classification / diagnosis

-Acute=exacerbaed by movememnt

-Muscle spasms=limit mobility

-Nerve involvement=numbness/tingling

-Diagnostics: history and examination, X-Ray, CT, MRI, Electromyography, myelogram

Low back pain treatment

Conservative management:

-Nonpharm: physical therapy patient education of posture / lifting, limit movement, strengthening, etc

-Pharm: Acetaminophen, NSAIDS, muscle relaxants, opioids, corticosteroids, anti seizure drugs, antidepressants

-Surgical: for cases unresponsive to conservative treatment: spinal fusion / disectomy

Herniated disc

“Slipped disc”=bulges outward between the vertebrae

-Most common sites= L4-L5m L5-S1, C5-C6, and C6-C7

-Caused by repeated stress, trauma, spinal stenosis

-Can press against nerves and cause pinched nerves=radiculopathy (radiating symptoms)

Cauda Equina

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

-Cauda Equina SYndrome: The nerves in the Cauda Equina are compressed. Is a serious condition that requires immediate surgery to prevent permanent nerve and muscle damage

-Some s/sx: Weakness / numbness in the legs, numbness around the genitals, urination control, bowel movement issues, loss of sexual sensation

Cauda Equina Syndrome: Know The Signs

Saddle anesthesia

Pain

Incontinence

Numbness

Emergency

Cue recognition

-Cervical spine: pain radiates to arms and hands, shoulder pain, weak or absent reflexes, weak hand grip

-Lumbar: low back pain (shooting or stabbing), radiculopathy (pain radiation / sciatica), + straight leg test, depressed or absent reflexes, paresthesia, muscle weakness

Nursing management and intervention for spinal pathophysiology

-Assessment: vital signs, pain, mobility, numbness/tingling, bowel function, depression/SI

-Actions: pain meds as ordered, range of motion exercises, increase fluid intake, William’s position, avoid painful positioning, emotional support, education, post-surgical care

Cervical Discectomy / Fusion

A surgical procedure to remove a portion of a herniated or degenerative disc in the cervical spine to relieve pressure on spinal nerves or the spinal cord / permanently joins two or more vertebrae in the neck to stop painful motion or relieve pressure

-NURSING MANAGEMENT POST OP: AIRWAY,BREATHING,CIRCULATION / neuro / swallowing ability / pain / neck color / education

Spinal Cord Injury

SCI results from trauma that damages the spinal cord, leaving to partial or complete loss of motor / sensory / autonomic function below the injury site

-Rx: ages 16–18, male, high-risk physical activity, DWI

-Daignosis:neuro exam, X-ray, CT, MRI

SCI cues

-Complete SCI: total loss of motor an sensory function below the injury level

-Incomplete SCI: varying degrees of motor and sensory loss

-Autonomic dysreflexia, htn, Brady, bowel/bladder dysfunction, inability to breathe, paraplegia, etc ALL DEPEND ON THE LEVEL OF INJURY

Autonomic dysreflexia

A potentially life-threatening conditions hat occurs in people with SCIs, typically at or above the level of T6

-It’s caused by an overreaction of the ANS to a stimulus below the level of the injury

-This overreaction can lead to a dangerous increase in BP

-Triggers: full bladder, bowel, skin irritation

-Signs and symptoms: Sudden severe headache, flushed face, htn, brady, sweating, cold, pale skin

The - the injury, the - the loss of function

Higher/Greater

-Injuries above C4=paralysis of respiratory muscles AND all four extremities (quadriplegia)

-Temperature regulation and other problems below the level of injury may also occur

Spinal Cord Injury treatment

Acute management and immobilization

-Maintain patent airway corticosteroids to reduce inflammation, surgery to stabilize the spine (laminectomy or fusion)

-Rehab: PT, OT, psychological support

-ASSESS RT FUNCTION, VS, motor / sensory function, pain, I and O, etc.

-Actions: Suction, coughing, spinal immobilization, reposition, education on RTF

Spinal Cord Injury classifications

-Mechanism: Consistent or intermittent compression, distraction (tearing), transaction

-ClassificatioN: complete vs incomplete, paraplegia vs tetraplegia

Complete vs incomplete and paraplegia vs tetraplegia SCI

Complete injuries result in total loss of function below the injury level, while incomplete injuries allow some preserved function/Paraplegia affects the lower limbs, and tetraplegia affects all four limbs

SCI clinical presentation

-Tetraplegia: between C1 to T1

-Paraplegia: between T2-S5

-Spinal shock

-Lab testing and diagnostic studies

Spinal cord injuries: epidemiological and etiological rx

-Damage or trauma to SC, vertebrae, ligaments, discs. Leading causes are MVAs and Falls

-Over 60 years old worsens outcomes (age/bone related)

-Comorbidities: HTN, arthritis, DM, HLD, obesity, depression, alcoholism

-Complications: Spasticity, UTIs, chronic pain, sexual / bladder / bowel dysfunction

Glasgow Coma Scale

A scale used to assess the level of consciousness in a person following a traumatic brain injury. It evaluates three aspects: eye opening, verbal response, and motor response, with scores ranging from 3 to 15

SCI complications

-Venous thromboembolism, atelectasis and pneumonia (THE LEADING CUASE OF DEATH), autonomic dysreflexia (can be triggered by noxious smells)

Heterotopic ossification

Abnormal bone growth in soft tissues, often around joints and following spinal cord injuries

-can lead to pain, restricted movement, and complications in rehabilitation

What does the peripheral nervous system do?

The peripheral nervous system connects the central nervous system to limbs and organs, facilitating communication between the body and the brain

-It includes sensory and motor pathways that control voluntary and involuntary functions

Myasthenia Gravis

PNS chronic autoimmune disorder that affects nerve cell communication with muscles

-The body produced antibodies that attack ACh receptors on the muscle surface necessary for contraction, leading to:

-Impaired nerve impulses to muscles, fluctuating muscle, weakness (particularly with repetitive use), fatiguability that worsens with activity and improves with rest

-Areas affected: ocular / facial / throat / limb / respiratory muscles

Fatigueability

uncle weakness that 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

-Triggers: infection / stress / surgery / inadequate medication

MG txt and diagnoses

-Diag:Acetylcholine receptors antibody test, Electromyography, tension test, chest CT or MRI

-Txt: Anticholinesterase drugs, immunosuppressants, IVIG, Plasmapheresis

-Surgery: thymectomy: surgical removal of the thymus gland, which can result in long-term improvement or remission in some patients

Guillain-Barré syndrome

An acute, autoimmune disorder in which the body’s immune system attacks the PNS, leading to inflammation and the demyelination of nerves

-Results in impaired nerve signal transmission, primarily affecting motor function but can also involve sensory and autonomic nerves

-Unknown cause, but often triggered by a preceding infection, such as RT or GI illness / viral infection

GBS Diagnostics

-Lumbar puncture=increased protein levels in the CSF with a normal WBC = KEY

-EMG / Nerve Conduction Studies: COnfirms nerve dysfunction by showing delayed or absent conduction

-Others: MRI to rule out causes of weakness, Pulmonary function tests to assess RT involvement

Clinical manifestations of GBS

-Motor: ascending weakness starting int he legs and progressing to the upper limbs / face, reduced or absent DTR, difficulty with ambulation or RT muscles

-Sensory: Tingling or numbness in extremities, pain

-Autonomic dysfunction: BLOOD PRESSURE

In GBS, be sure to -

Assess autonomic functions (RR CV), motor functions, pain, and psychosocial status

Multiple Sclerosis

A chronic autoimmune disease affecting the central nervous system, characterized by demyelination of nerve fibers, leading to varied neurological symptoms such as fatigue, motor dysfunction, and cognitive impairment

-Immune system mistakes myelin-sheath, the protective covering of nerves fibers, as a threat

-LOSS OF MYELIN EADS TO FORMATION OF HARD, SCAR-LIKE AREAS THAT ARE SCLEROTIC PLAQUES AND LESIONS IN THE BRAIN / SC

McDonald’s Criteria

A diagnostic criteria used for MS. Damage in at least 2 different areas of the CNS (brain / optic nerves / SC) with damage that occurred at different times

-Sclerotic plaque in the white matter of the brain is a consistent finding

Types of MS

-Relapse-remitting most common type, clearly defined flare-ups followed by remission

-Secondary-progressive: begins as relapse-remitting but progresses to steady form with occasional relapses

-Primary-Progressive: gradual progression of symptoms from onset with NO relapses or remission

-Clinically-Isolating Syndrome: earliest form of MS. Symptoms last for 24 hours and can’t be explained by another cause (infection)

-Only one clinical attack does not meet the criteria, has to be multiple over time

MS rx factors

-Unknown etiology, but contributing factors are: autoimmune, genetic, environmental (vit D deficiencies, infections, EBV), usually between 20-40

-Comorbidities: Cerebrovascular, cardiovascular, depression, anxiety, autoimmune disorders, COP , DM, HLD, HTN

MS impact on health

Visual impairment, immune system issues, cognition, pain, mobility, psychosocial (anxiety / depression treatment) , aging, diet, relapse, temperature sensitivity, sexual function

MS diagnosis / medical management

Difficult to diagnose because there is no one specific test, ruling out conditions with similar clinical presentations helps

-ID of brain lesions / plaques on MRI, electrophysiological tests + evoked potential to examine how quickly impulses are traveling through the nerves

-The patient must have two separate symptomatic events or MRI changes in at least two separate locations

MS clinical presentations

Manifestations are very broad and associated with the amount and location of lesions / amount of tissue damage

-Vision changes, muscle weakness / stiffness // spasms, numbness or pain, loss of balance, difficulty with cognitive function, mood changes

-Be sure to assess neuromuscular function, vision / eye movement, skin integrity, ability to perform ADLs, and bowel / bladder function