Neurocritical Care

iv.

ASIA D: Incomplete, motor function is preserved below the neurological level of injury, and at

least half the key muscles below the injury level have a muscle grade of 3 or more (i.e., joints

can be moved against gravity)

ASIA E: Normal, motor and sensory functions are normal

CT scan of spine

40%–50% are caused by motor vehicle collisions.

Mortality

50%–75% at the time of injury

Hospital mortality 4.4%–16%

Paralysis and loss of sensation

Spasticity

Orthostatic hypotension

VTE

Decubitus ulcers

Respiratory insufficiency

Bowel and bladder dysfunction

Sexual dysfunction

Treatment considerations

Hypotension often occurs after injury (50%–90% of cervical spine injuries).

ii.

May be associated with malperfusion of the spinal cord and worsened outcomes

iii.

Etiology of shock is decreased sympathetic nervous system outflow. Continues to be

counterbalanced by parasympathetic outflow, which is not affected by SCI

iv.

Results in hypotension and bradycardia

Blood Pressure Management

Typical recommendations after an acute SCI are to maintain MAP 85–90 mm Hg for 7 days to ensure

adequate spinal perfusion.

SCI guidelines as a treatment option.

Often requires judicious fluid resuscitation and vasopressor support

Persistent hypotension may be treated with fludrocortisone or midodrine.

Persistent bradycardia may be treated with pseudoephedrine or low-dose theophylline.

Droxidopa, an enteral analog of norepinephrine, may be useful for blood pressure augmentation in this

setting.

VTE occurs in 80%–100% of patients without pharmacologic prophylaxis