I'd like to now go over a couple of additional cases just to round this out with some scenarios. We've got a 45-year-old man with a T8 complete paraplegia for 30 years who presents with complaints of a loss of grip strength and numbness in his little fingers bilaterally. Your physical examination shows atrophy of the hand intrinsic muscles and decreased sensation in the C8 dermatome. Nerve conduction study shows no evidence of ulnar neuropathy, but the EMG shows membrane instability in the C8 muscles bilaterally. What would be your next step? Would you repeat the nerve conduction study and EMG in a month? Would you get surgical consultation for an ulnar nerve decompression? Would you refer them to OT for adaptive equipment? Would you obtain an MRI of the upper thoracic and lower cervical spinal cord? Or provide a power chair? Because syringomyelia, the most likely cause of ascending loss of sensation in the absence of ulnar nerve damage on EMG, then the MRI would be the most useful study. If you see a syrinx, we need to know whether it's expanding and often the neurosurgeons will ask for a period of watchful waiting. But if there is evidence of continued decline, neurosurgical intervention for that syringomyelia would be necessary for any sort of resolution and prevention of progression. A 30 year old woman with C7 complete tetraplegia is now 30 week pregnant. She has questions about delivery and appropriate anesthesia. What do you tell her? You're pregnant? How could that happen? B, talk to your OB. I don't know anything about that. C, it'll be easy. You won't need an epidural because you can't feel anything. D, you'll have to have a C-section because of your paralysis. You can't push. Or E, a vaginal delivery is possible, but you should have an epidural to prevent AD. And the answer is E, a vaginal delivery is possible, but an epidural is necessary to prevent dysreflexia. It's important to remember that vaginal delivery is possible in most cases, although forceps may be necessary. Epidural anesthesia is essential during delivery for any woman at risk for dysreflexia. And although she should discuss these things with her OB, you as her spinal cord injury doctor should be able to discuss these options with her as well. A 43-year-old woman with a C7 Asia B tetraplegia for 12 years presents with increased spasticity, lower abdominal pain, urinary incontinence, and headache. Her blood pressure is 130 over 85, pulse is 60. What is your diagnosis? Is this a urinary tract infection? Is this autonomic dysreflexia? Is this a possible bladder stone? Or could this be all of the above? And the answer is all of the above. This patient has signs and symptoms of autonomic dysreflexia, and that needs to be managed acutely. But the cause of the dysreflexia is likely to be a urinary tract infection or bladder stone based on her urinary complaints. This concludes the focus review for spinal cord injury. I thank you for your attention and participation in this activity.

spinal cord injuries

syringomyelia

tetraplegia

dysreflexia

urinary tract infection