Spinal shock

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Spinal Shock

Spinal shock is the altered physiologic state immediately after a spinal cord injury, which present as loss spinal cord function caudal to the level of the injury, with flaccid paralysis, anesthesia, absent bowel and bladder control, and loss of reflex activity.

Phases of spinal shock:

§  Areflexia/ hyporeflexia (below normal reflexes), flaccid paralysis, loss of sensation

§  Initial reflex return

§  Early hyperreflexia

§  Late hyperreflexia.

Pathophysiology of spinal shock:

§  The transection of the spinal cord results in spinal shock and transient extinction of reflexes below the level of injury.

§  The main pathophysiological mechanisms include: Synaptic changes in cord segments below the level of injury due to enhancement of presynaptic inhibition and high concentration of glycine.

Causes of spinal shock:

§  Spinal shock is a result of severe spinal cord injury.

§  It usually requires high-impact, direct trauma that leads to severe spinal cord injury and spinal shock.

§  The initial encounter with a patient with spinal shock is usually under a trauma scenario.

§  Spinal shock is caused by swelling following damage to the spinal cord. Generally, swelling peaks at about 3-6 days post-injury.

§  Swelling of the spinal cord can further restrict blood flow, which disrupts the delivery of oxygen and other essential nutrients to tissues.

§  As a result, autoregulation below the level of injury becomes impaired. Our bodies need blood to fuel cellular activity. Without sufficient amounts of it, cells may be damaged and the body can start to dysfunction.

Signs and symptoms of spinal shock:

§  Loss of reflexes.

§  Altered body temperature.

§  Loss of motor control.

§  Skin color and moisture changes.

§  Low blood pressure – if the SCI occurs at the T6 level or higher.

§  Abnormal perspiration – decreased or increased sweating, flushing.

§  Decreased heart rate – if the spinal cord injury at the T6 level or higher.

§  Irregularities in the musculoskeletal system.

§  Flaccid paralysis. Weakness, incoordination or paralysis in any part of the body.

§  Spasms/increased muscle tone.

§  Loss of bladder or bowel control.

§  Numbness, tingling or loss of sensation in hands, fingers, feet or toes.

§  Difficulty with balance and walking.

Characteristic of spinal shock:

§  Motor effects – Paraplegia, quadriplegia

§  Loss of tone – Muscles become flaccid

§  Areflexia – All superficial and deep reflexes are lost

§  Sensory effects – All sensations are lost below the level of transection

§  Complete lesions above T1 will eliminate all sympathetic outflow

§  Lesions between T1 and T6 will preserve sympathetic tone in head and upper extremities but deny it to the adrenals and lower extremities

§  Lesions between T6 and the lumbar cord will preserve adrenal innervation but denervation the lower extremities. 

Manifestations of spinal shock:

§  Spinal shock is characterized by a temporary rise in blood pressure that is proceeded by hypotension, flaccid paralysis, urinary retention and fecal urinary incontinence.

§  If reversal of symptoms does not occur within 24hrs, it may call for protracted recovery time and lengthened stay in rehabilitation.

Vitamins for spinal cord injury:

Vitamin B12:

§  Vitamin B12 deficiencies can cause tiredness, weakness, constipation, loss of appetite, tingling, and numbness.

§  This vitamin also plays a fundamental role in producing red blood cells, which are essential for carrying oxygen throughout the body.

§  Vitamin B12 in foods like fish, meat, and dairy.

Vitamin B9:

§  It comes in 2 different forms: folate and folic acid.

§  Folate is naturally, derived and found in dark green vegetables like spinach, asparagus, and broccoli.

§  Folic acid is the synthetic form of B9 that you can find in pills.

§  Folic acid can effectively reduce the occurrence of neural tube defects in newborns.

Vitamin D:

§  Due to paralysis, many individuals with spinal cord injuries lose the ability to independently stand and walk.

§  Vitamin D aids the absorption of calcium in the body, which is essential for maintaining strong bones.

§  It also helps trigger immune cells to produce antibodies, which helps strengthen the immune system and protect the body.

§  One of the best ways to get daily dose of vitamin D is to get out in the sun.

§  Vitamin D in foods like fatty fish and egg yolks or take supplements.

Omega-3 fatty acids:

§  Docosahexaenoic acid is an omega3- fatty acid that is essential for central nervous system health.

§  The excessive release of glutamate overstimulates the spinal cord and causes neurons to die in a process called excitotoxicity. DHA helps prevent excitotoxicity by regulating glutamate levels, which helps reduce overall damage to the spinal cord.

§  Good food sources of omega-3 include flaxseeds, walnuts, and salmon.

Vitamin C:

§  Vitamin C is essential for spinal cord injury recovery because it helps the body repair tissues and produce neurotransmitters.

§  Vitamin C is also a well-known antioxidant that can help combat oxidative stress and limit cell deaths after a spinal cord injury.

§  It can be found in lots of fruits and vegetables, including citrus fruits, strawberries, and red peppers.

Magnesium:

§  Magnesium has neuroprotective properties that can help limit secondary damage to the spinal cord.

§  It also plays an important role in various bodily reactions including nerve impulse conduction, muscle contractions, and energy protection.

§  Good sources of magnesium include spinach, pumpkin seeds, and tuna.

Vitamin E:

§  Vitamin E is a major antioxidant that can help reduce oxidative stress and overall damage after a spinal cord injury.

§  It is also involved in immune functions, signaling between cells, and other metabolic processes.

§  Vitamin E can be found in foods like sunflower seeds, almonds, and vegetable oils.

Treatment:

§  Physical therapy.

§  Exercise therapy to strengthen muscles and maintain a healthy body weight.

§  Psychotherapy to aid in coping with and managing the injury.

§  Early medical intervention is crucial in the treatment of spinal cord injuries. By stabilizing the spinal cord as quickly as possible, the individual’s medical team may minimize the progression of swelling and other secondary processes that contribute to spinal shock. This helps reduce overall damage to the spinal cord.

§  As a temporary outcome of spinal cord should resolve on its own.

§  Medications such as painkillers, antibiotics, and antidepressants.

Eczema

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Eczema/Itchy Skin

Itching of the skin:

Itchy skin is a warning sign when an unwanted substance enters the body. Physiologically speaking, itchy skin is an allergic reaction. It is the mast cells in our skin that do this. Mast cells are an important immune cell type in the skin and play an active role during wound healing. When the skin is itchy, it feels good to scratch it. If it continues, it turns out to be irritating and resentful.

Medical Causes:

·        The underlying cause is an immune protein that builds up in the blood to an unwanted substance. This is called immunoglobulin E (IgE). Blood cells make this protein. When an unwanted substance first enters the body, this protein is formed, waits in the blood, and causes damage.

·        Skin conditions. Examples include dry skin, dermatitis, psoriasis, scabies, parasites, burns, scars, insect bites and hives.

·        Nerve disorders

·        Irritation and allergic reactions.

·        In older people, the oil glands in the skin diminish, causing dryness and itchiness.

Causes:

·        The first reason is synthetic beauty products. Soap, scent, vermillion, hair dye, lipstick, nail polish, face powder, cream etc. can cause irritation if they are not compatible with the skin.

·        For some people, if they wear clothes made of wool, terlin, nylon, animal skin, the body starts to itch.

·        For babies, if the diaper doesn’t conform, itches in the buttocks.

·        Rubber slippers, watch strap, paint, pesticides, chemicals etc. can also cause irritation.

·        For women of our country, nickel type jewelry causes more itching.

·        Detergent powder or soap used for washing clothes can be allergic to some people and cause irritation.

·        During the hot season, the skin becomes allergic and itchy due to the UV rays of the sun. profuse sweating also causes itching. The cold air in winter makes the skin dry and itchy.

·        In areas that secrete a lot of sweat, the fungus can enter and cause itching. This itching is intense at night. Jock itch is a fungal infection that causes a red and itchy rash in warm and moist areas of the body.

·        Milk, curd, egg, shrimp, meat, sea fish, dry fish, tomato etc. can cause skin irritation.

·        Some medications that we take can also cause itching.

Eczema:

Atopic dermatitis is a condition that makes the skin red and itchy. Atopic dermatitis is chronic and tends to flare periodically. No cure has been found for atopic dermatitis.

Symptoms in children:

Children and teens usually have a rash in the bends of their elbows, behind their knees, on their neck, or on their wrists or ankles. The rash turns scaly and dry.

Symptoms in adults:

The rash usually happens on your face, the backs of your knees, wrists, hands, or feet. In fair-skinned people, these areas may start out reddish and then turn into brown. In darker-skinned people, eczema can affect skin pigments, making the affected area lighter or darker.

Types of eczema:

1.     Atopic dermatitis:

It is the most common form of eczema. Atopic dermatitis is part of what healthcare professionals call the atopic triad. The other two diseases in the triad are asthma and hay fever. Many people with atopic dermatitis have all three conditions.

Symptoms:

v The rash often forms in the creases of elbows or knees.

v Small bumps may appear and leak fluid if scratch them.

v Skin can get infected if scratch it.

v The skin in areas where the rash appears may turn lighter or darker or get thicker.

Causes:

v Atopic dermatitis happens when the skin’s natural barrier against the elements is weakened. This means the skin is less able to protect from irritants and allergens.

v Atopic dermatitis is likely caused by a combination of factors such as:

·        Genes

·        Dry skin

·        An immune system problem

·        Triggers in the environment.

2.     Contact dermatitis:

If you have red, irritated skin, thick scaly region that’s caused by a reaction to substances you touch, you may have contact dermatitis. It comes in two types.

v Allergic contact dermatitis

v Irritant contact dermatitis.

Symptoms:

v Skin itches, turns red, is hyperpigmented or pink, magenta, burns and stings.

v Itchy bumps called hives may appear on the skin.

v Over time, the skin may thicken and feel scaly or leathery.

Causes:

v Detergents

v Jewelry

v Latex

v Poison ivy and other poisonous plants

v Soaps and perfumes

v Tobacco smoke.

3.     Dyshidrotic eczema:

Dyshidrotic eczema causes small blisters to form on your hands and feet.

Symptoms:

v Fluid-filled blisters form on your fingers, toes, and the soles of the feet.

v Skin can scale, crack, and flake.

Causes:

v Allergies

v Exposure to substances, such as nickel, cobalt, or chromium salt

v Smoking tobacco products.

4.     Hand eczema:

Eczema that only affects the hands is called hand eczema.

Symptoms:

v Hands get red, hyperpigmented, itchy, and dry.

Causes:

Hand eczema is triggered by exposure to chemicals. People are more likely to get this form if they work in jobs that expose them to irritants, such as:

v Cleaning

v Health care

v Laundry or dry cleaning.

5.     Neurodermatitis:

Neurodermatitis is similar to atopic dermatitis. It causes thick, scaly patches to appear on the skin.

Symptoms:

v Thick, scaly patches form on the arms, legs, back of the neck, scalp, bottoms of the feet, back of the hands, or genitals.

v The patches can bleed and get infected if scratch them.

Causes:

Doctors don’t know exactly what causes it, but stress can be a trigger.

6.     Nummular eczema:

This type of eczema causes round, coin-shaped spots to form on the skin. The word “nummular” means coin in Latin.

Symptoms:

v Round, coin-shaped spots form on the skin.

v The spots may itch or become scaly.

Causes:

v Nummular eczema can be triggered by a reaction to an insect bite or an allergic reaction to metals or chemicals.

v Dry skin can also cause it.

7.     Stasis dermatitis:

Stasis dermatitis happens when fluid leaks out of weakened veins into the skin. This fluid causes:

·        Swelling

·        Brown, purple, gray or ashen color in darker skin tones

·        Itching

·        Pain.

Symptoms:

v The lower part of the legs may swell, especially during the day when you have been walking.

v You will likely also have varicose veins, which are thick, ropey damaged veins in your legs.

v You may develop open sores on your lower legs and on the tops of your feet.

Causes:

v Stasis dermatitis happens in people who have blood flow problems in their lower legs.

v If the valves that normally push blood up through the legs toward the heart malfunction, blood can pool in the legs. Legs can swell up and varicose veins can form.