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Page 1: Waleed Awwad, MD, FRCSC. Introduction Multiple injuries. Brain injury. Spinal injury. Area of injury. 5% of patent with neurological symptom. Excluding

Waleed Awwad, MD, FRCSC

Waleed Awwad, MD, FRCSC

Page 2: Waleed Awwad, MD, FRCSC. Introduction Multiple injuries. Brain injury. Spinal injury. Area of injury. 5% of patent with neurological symptom. Excluding

Introduction• Multiple injuries.• Brain injury.• Spinal injury.• Area of injury.• 5% of patent with neurological

symptom.• Excluding the presence of spinal

injury.

• Multiple injuries.• Brain injury.• Spinal injury.• Area of injury.• 5% of patent with neurological

symptom.• Excluding the presence of spinal

injury.

Page 3: Waleed Awwad, MD, FRCSC. Introduction Multiple injuries. Brain injury. Spinal injury. Area of injury. 5% of patent with neurological symptom. Excluding

Anatomy• Spinal Column

Page 4: Waleed Awwad, MD, FRCSC. Introduction Multiple injuries. Brain injury. Spinal injury. Area of injury. 5% of patent with neurological symptom. Excluding

Anatomy• Spinal Column

Page 5: Waleed Awwad, MD, FRCSC. Introduction Multiple injuries. Brain injury. Spinal injury. Area of injury. 5% of patent with neurological symptom. Excluding

Anatomy• Spinal Column

Page 6: Waleed Awwad, MD, FRCSC. Introduction Multiple injuries. Brain injury. Spinal injury. Area of injury. 5% of patent with neurological symptom. Excluding

Anatomy• Spinal Column

Page 7: Waleed Awwad, MD, FRCSC. Introduction Multiple injuries. Brain injury. Spinal injury. Area of injury. 5% of patent with neurological symptom. Excluding

Anatomy• Spinal Column

Page 8: Waleed Awwad, MD, FRCSC. Introduction Multiple injuries. Brain injury. Spinal injury. Area of injury. 5% of patent with neurological symptom. Excluding

Anatomy• Spinal Column

Page 9: Waleed Awwad, MD, FRCSC. Introduction Multiple injuries. Brain injury. Spinal injury. Area of injury. 5% of patent with neurological symptom. Excluding

Anatomy• Spinal Column

Page 10: Waleed Awwad, MD, FRCSC. Introduction Multiple injuries. Brain injury. Spinal injury. Area of injury. 5% of patent with neurological symptom. Excluding

Anatomy• Spinal Column

Page 11: Waleed Awwad, MD, FRCSC. Introduction Multiple injuries. Brain injury. Spinal injury. Area of injury. 5% of patent with neurological symptom. Excluding

Anatomy• Spinal Cord

Page 12: Waleed Awwad, MD, FRCSC. Introduction Multiple injuries. Brain injury. Spinal injury. Area of injury. 5% of patent with neurological symptom. Excluding

Anatomy• Spinal Cord

Page 13: Waleed Awwad, MD, FRCSC. Introduction Multiple injuries. Brain injury. Spinal injury. Area of injury. 5% of patent with neurological symptom. Excluding

Anatomy• Spinal Cord

• Complete spinal cord injury.

• Incomplete spinal cord injury.

• Sacral sparing.

• Neurogenic shock Vs Spinal shock

• Spinal Cord

• Complete spinal cord injury.

• Incomplete spinal cord injury.

• Sacral sparing.

• Neurogenic shock Vs Spinal shock

Page 14: Waleed Awwad, MD, FRCSC. Introduction Multiple injuries. Brain injury. Spinal injury. Area of injury. 5% of patent with neurological symptom. Excluding

AnatomySensory Examination C5 over deltoid

C6 Thumb C7 Middle finger C8 Little finger T4 Nipple T8 Xiphisternum T10 Umbilicus T12 Symphysis pubis L4 medial aspect of calf L5 Web space 1st & 2nd toe S1 Lateral border of the foot S4-5 Perianal region

Sensory Examination C5 over deltoid

C6 Thumb C7 Middle finger C8 Little finger T4 Nipple T8 Xiphisternum T10 Umbilicus T12 Symphysis pubis L4 medial aspect of calf L5 Web space 1st & 2nd toe S1 Lateral border of the foot S4-5 Perianal region

Page 15: Waleed Awwad, MD, FRCSC. Introduction Multiple injuries. Brain injury. Spinal injury. Area of injury. 5% of patent with neurological symptom. Excluding

Anatomy• Myotomes

C5 Deltoid C6 wrist extensors C7 Elbow extensors C8 finger flexors T1 Small finger abductor L2 Hip flexors L3-4 Knee extensors L 4,5 S1 Knee flexion L5 Ankle and big toe dorsiflextion S1 Ankle planter flexors

• Myotomes

C5 Deltoid C6 wrist extensors C7 Elbow extensors C8 finger flexors T1 Small finger abductor L2 Hip flexors L3-4 Knee extensors L 4,5 S1 Knee flexion L5 Ankle and big toe dorsiflextion S1 Ankle planter flexors

Page 16: Waleed Awwad, MD, FRCSC. Introduction Multiple injuries. Brain injury. Spinal injury. Area of injury. 5% of patent with neurological symptom. Excluding

Classification Level.

Severity.

Spinal cord syndrome.

Morphology.

Of spinalCord injury

Page 17: Waleed Awwad, MD, FRCSC. Introduction Multiple injuries. Brain injury. Spinal injury. Area of injury. 5% of patent with neurological symptom. Excluding

Classification Level

Neurologic level.

Sensory level.

Motor level.

T1 level

Level

Neurologic level.

Sensory level.

Motor level.

T1 level

Of spinalCord injury

Page 18: Waleed Awwad, MD, FRCSC. Introduction Multiple injuries. Brain injury. Spinal injury. Area of injury. 5% of patent with neurological symptom. Excluding

Classification Severity of neurologic deficit

Complete

Incomplete

? Any sensation ? Sacral spairing

Severity of neurologic deficit

Complete

Incomplete

? Any sensation ? Sacral spairing

Of spinalCord injury

Page 19: Waleed Awwad, MD, FRCSC. Introduction Multiple injuries. Brain injury. Spinal injury. Area of injury. 5% of patent with neurological symptom. Excluding

Classification Spinal cord Syndromes

Central cord syndrom.

Anterior cord syndrom.

Brown-Sequard’s Syndrom.

Spinal cord Syndromes

Central cord syndrom.

Anterior cord syndrom.

Brown-Sequard’s Syndrom.

Of spinalCord injury

Page 20: Waleed Awwad, MD, FRCSC. Introduction Multiple injuries. Brain injury. Spinal injury. Area of injury. 5% of patent with neurological symptom. Excluding

Classification Central Cord Syndrom

# Characterized by disproportionally.

# Mechanism: # Occure with or without… # Recovery… # Prognosis… # Due to…

Central Cord Syndrom

# Characterized by disproportionally.

# Mechanism: # Occure with or without… # Recovery… # Prognosis… # Due to…

Of spinalCord injury

Page 21: Waleed Awwad, MD, FRCSC. Introduction Multiple injuries. Brain injury. Spinal injury. Area of injury. 5% of patent with neurological symptom. Excluding

Classification Anterior Cord Syndrom

# Characterized..

# Posterior column Function

# Due to…

# Prognosis…

Anterior Cord Syndrom

# Characterized..

# Posterior column Function

# Due to…

# Prognosis…

Of spinalCord injury

Page 22: Waleed Awwad, MD, FRCSC. Introduction Multiple injuries. Brain injury. Spinal injury. Area of injury. 5% of patent with neurological symptom. Excluding

Classification Brown-Sequard’s Syndrome # Occurance..

# Due to…

# Characteristic…

Brown-Sequard’s Syndrome # Occurance..

# Due to…

# Characteristic…

Of spinalCord injury

Page 23: Waleed Awwad, MD, FRCSC. Introduction Multiple injuries. Brain injury. Spinal injury. Area of injury. 5% of patent with neurological symptom. Excluding

Classification Morphology

# Fractures.

# Fracture dislocations.

# SCIWORA.

# Penetrating Injury.

# Blunt trauma.

Morphology

# Fractures.

# Fracture dislocations.

# SCIWORA.

# Penetrating Injury.

# Blunt trauma.

Of spinalCord injury

Page 24: Waleed Awwad, MD, FRCSC. Introduction Multiple injuries. Brain injury. Spinal injury. Area of injury. 5% of patent with neurological symptom. Excluding

Classification

Of spinalCord injury

Page 25: Waleed Awwad, MD, FRCSC. Introduction Multiple injuries. Brain injury. Spinal injury. Area of injury. 5% of patent with neurological symptom. Excluding

Classification

Of spinalCord injury

Page 26: Waleed Awwad, MD, FRCSC. Introduction Multiple injuries. Brain injury. Spinal injury. Area of injury. 5% of patent with neurological symptom. Excluding

Classification

Of spinalCord injury

Page 27: Waleed Awwad, MD, FRCSC. Introduction Multiple injuries. Brain injury. Spinal injury. Area of injury. 5% of patent with neurological symptom. Excluding

Classification

Of spinalCord injury

Page 28: Waleed Awwad, MD, FRCSC. Introduction Multiple injuries. Brain injury. Spinal injury. Area of injury. 5% of patent with neurological symptom. Excluding

Classification

Of spinalCord injury

Page 29: Waleed Awwad, MD, FRCSC. Introduction Multiple injuries. Brain injury. Spinal injury. Area of injury. 5% of patent with neurological symptom. Excluding

Classification

Of spinalCord injury

Page 30: Waleed Awwad, MD, FRCSC. Introduction Multiple injuries. Brain injury. Spinal injury. Area of injury. 5% of patent with neurological symptom. Excluding

Classification

Of spinalCord injury

Page 31: Waleed Awwad, MD, FRCSC. Introduction Multiple injuries. Brain injury. Spinal injury. Area of injury. 5% of patent with neurological symptom. Excluding

Specific types Atlanto-occipital dislocation. Atlas fracture. Axis fractures: Odontoid fracture. Posterior element fracture of C2.

Fractures and dislocations ( C3-C7 ). Thoracic spine fractures. Thoracolumber junction fractures. Lumbar fractures.

Page 32: Waleed Awwad, MD, FRCSC. Introduction Multiple injuries. Brain injury. Spinal injury. Area of injury. 5% of patent with neurological symptom. Excluding

Specific types Atlanto-occipital dislocation.

# Uncommon.

# Sever flexion and Distraction.

# Prognosis…

# Shaken baby syndrom.

# Traction??

Atlanto-occipital dislocation.

# Uncommon.

# Sever flexion and Distraction.

# Prognosis…

# Shaken baby syndrom.

# Traction??

Page 33: Waleed Awwad, MD, FRCSC. Introduction Multiple injuries. Brain injury. Spinal injury. Area of injury. 5% of patent with neurological symptom. Excluding

X-Ray Evaluation

C-Spine X-ray. lateral, open mouth and Flex-Ext.

CT-Scan.

MRI.

CT myelography.

Page 34: Waleed Awwad, MD, FRCSC. Introduction Multiple injuries. Brain injury. Spinal injury. Area of injury. 5% of patent with neurological symptom. Excluding

X-Ray Evaluation

Page 35: Waleed Awwad, MD, FRCSC. Introduction Multiple injuries. Brain injury. Spinal injury. Area of injury. 5% of patent with neurological symptom. Excluding

Rad. Evaluation

Page 36: Waleed Awwad, MD, FRCSC. Introduction Multiple injuries. Brain injury. Spinal injury. Area of injury. 5% of patent with neurological symptom. Excluding

management Immobilization

Page 37: Waleed Awwad, MD, FRCSC. Introduction Multiple injuries. Brain injury. Spinal injury. Area of injury. 5% of patent with neurological symptom. Excluding

management IV Fluids. Medications. Vasopressors: Phynylephrine, Dopamine

or NE Steroids:

> Within .. > First 3hrs… > Between 3-8hrs….

IV Fluids. Medications. Vasopressors: Phynylephrine, Dopamine

or NE Steroids:

> Within .. > First 3hrs… > Between 3-8hrs….

Page 38: Waleed Awwad, MD, FRCSC. Introduction Multiple injuries. Brain injury. Spinal injury. Area of injury. 5% of patent with neurological symptom. Excluding

Thank you


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