ICU · Trauma / neurocritical care

Spinal Trauma & Spinal Shock — ASIA Scale, CT vs MRI & Steroid Controversy

Also known as Spinal cord injury · SCI · Spinal shock · Neurogenic shock · ASIA impairment scale · NASCIS · Methylprednisolone spinal injury · Cervical spine clearance · Complete cord syndrome · Anterior cord syndrome · Central cord syndrome · Brown-Séquard syndrome · NEXUS criteria · Canadian C-spine rule · STASCIS · Autonomic dysreflexia

The spinal trauma and the spinal shock in the ICU: the spinal cord injury (the SCI — from the trauma, the fracture, the dislocation) causing the motor and sensory deficit below the level. The mechanism of injury (the axial loading, the flexion, the extension, the rotation, the distraction) determines the fracture pattern and the cord injury. The ASIA impairment scale (A = complete; B = sensory incomplete; C = motor incomplete; D = motor useful; E = normal). The spinal shock (the temporary the areflexia and the flaccidity below the level — the resolves over the days to the weeks) vs the neurogenic shock (the hypotension, the bradycardia, the vasodilation from the loss of the sympathetic tone — the T6 and above). The cervical spine clearance (the NEXUS low-risk criteria vs the Canadian C-spine rule; the CT first-line for the high-risk; the MRI for the neurological deficit; the clinical clearance for the low-risk). The imaging: the CT first (the bony), the MRI for the cord (the oedema, the haematoma, the compression). The steroids (the methylprednisolone — the NASCIS trials; the controversial; the not the standard of the care).