Spinal cord injuries

Spinal cord injury ICD-10 G959, T093 ICD-9 OMIM [1] EnfermedadesDB 12327 29466 Medline Plus [2] eMedicine emerg/553 neuro/711 pmr/182 pmr/183 orthoped/425 MeSH {{{Número de malla}}} Spinal cord injury causes myelopathy or damage to white matter or myelinated fiber tracts that carry sensation and motor signals to and from the brain. [1][2] It also damages gray matter in the central part of the spine, causing segmental losses of interneurons and motorneurons. Contents 1 Clasificación 2 The Effects of Spinal Cord Injury 2.1 The Location of the Injury 2.1.1 Cervical injuries 2.1.2 Thoracic injuries 2.1.3 Lumbar and Sacral injuries 2.1.4 Central Cord and Other Syndromes 3 Causas 4 Diagnóstico 5 Administración 5.1 Cirugía 5.2 Steroids 5.3 Rehabilitation 5.3.1 Outcome measures 6 Pronóstico 6.1 Tetraplegia (quadriplegia) 6.2 Paraplegia 7 Epidemiología 8 Research directions 8.1 Stem cells 8.2 BCI 9 Ver también 10 Referencias 11 External links Classification The American Spinal Injury Association (ASIA) first published an international classification of spinal cord injury in 1982, called the International Standards for Neurological and Functional Classification of Spinal Cord Injury(ISNCSCI) Y ahora, in its sixth edition, is still widely used to document sensory and motor impairments following SCI.[3] It is based on neurological responses, touch and pinprick sensations tested in each dermatome, and strength of ten key muscles on each side of the body, including hip flexion (L2), shoulder shrug (C4), elbow flexion (C5), wrist extension (C6), and elbow extension (C7).[4] Traumatic spinal cord injury is classified into five categories on the ASIA Impairment Scale: A indicates a "completo" spinal cord injury where no motor or sensory function is preserved in the sacral segments S4-S5. B indicates an "incomplete" spinal cord injury where sensory but not motor function is preserved below the neurological level and includes the sacral segments S4-S5. This is typically a transient phase and if the person recovers any motor function below the neurological level, that person essentially becomes a motor incomplete, es decir. ASIA C or D. C indicates an "incomplete" spinal cord injury where motor function is preserved below the neurological level and more than half of key muscles below the neurological level have a muscle grade of less than 3, which indicates active movement with full range of motion against gravity. D indicates an "incomplete" spinal cord injury where motor function is preserved below the neurological level and at least half of the key muscles below the neurological level have a muscle grade of 3 o más. E indicates "normal" where motor and sensory scores are normal. Note that it is possible to have spinal cord injury and neurological deficits with completely normal motor and sensory scores.[3] Dimitrijevic[5] proposed a further class, the so-called discomplete lesion, which is clinically complete but is accompanied by neurophysiological evidence of residual brain influence on spinal cord function below the lesion.[6] Además, there are several clinical syndromes associated with incomplete spinal cord injuries. The Central cord syndrome is associated with greater loss of upper limb function compared to lower limbs. The Brown-Séquard syndrome results from injury to one side with the spinal cord, causing weakness and loss of proprioception on the side of the injury and loss of pain and thermal sensation of the other side. The Anterior cord syndrome results from injury to the anterior part of the spinal cord, causing weakness and loss of pain and thermal sensations below the injury site but preservation of proprioception that is usually carried in the posterior part of the spinal cord. Tabes Dorsalis results from injury to the posterior part of the spinal cord, usually from infection diseases such as syphilis, causing loss of touch and proprioceptive sensation. Conus medullaris syndrome results from injury to the tip of the spinal cord, located at L1 vertebra. Cauda equina syndrome is, estrictamente hablando, not really spinal cord injury but injury to the spinal roots below the L1 vertebra. One can have spine injury without spinal cord injury. Many people suffer transient loss of function ("stingers") in sports accidents or pain in "whiplash" of the neck without neurological loss and relatively few of these suffer spinal cord injury sufficient to warrant hospitalization. En los Estados Unidos, the incidence of spinal cord injury has been estimated to be about 35 cases per million per year, or approximately 10,500 per year (35 * 300). En China, the incidence of spinal cord injury was recently estimated to be as high as 65 cases per million per year in urban areas. Si es así, assuming a population of 1.3 billion, this would suggest an incidence of 84,500 per year (65 * 1300).  The prevalence of spinal cord injury is not well known in many large countries. In some countries, such as Sweden and Iceland, registries are available. Sobre 450,000 people in the United States live with spinal cord injury (one in 670), and there are about 11,000 new spinal cord injuries every year (one in 30,000). The majority of them (78%) involve males between the ages of 16-30 and result from motor vehicle accidents (42%), violence (24%), or falls (27%). This is likely due to increased risk-taking behavior in men. The Effects of Spinal Cord Injury Divisions of Spinal Segments 150px Segmental Spinal Cord Level and Function Level Function Cl-C6 Neck flexors Cl-Tl Neck extensors C3, C4, C5 Supply diaphragm (mostly C4) C5, C6 Shoulder movement, raise arm (deltoid); flexion of elbow (biceps); C6 externally rotates the arm (supinates) C6, C7 Extends elbow and wrist (triceps and wrist extensors); pronates wrist C7, T1 Flexes wrist C7, T1 Supply small muscles of the hand T1 -T6 Intercostals and trunk above the waist T7-L1 Abdominal muscles L1, L2, L3, L4 Thigh flexion L2, L3, L4 Thigh adduction L4, L5, S1 Thigh abduction L5, S1, S2 Extension of leg at the hip (gluteus maximus) L2, L3, L4 Extension of leg at the knee (quadriceps femoris) L4, L5, S1, S2 Flexion of leg at the knee (hamstrings) L4, L5, S1 Dorsiflexion of foot (tibialis anterior) L4, L5, S1 Extension of toes L5, S1, S2 Plantar flexion of foot L5, S1, S2 Flexion of toes The exact effects of a spinal cord injury vary according to the type and level injury, and can be organized into two types: In a complete injury, there is no function below the "neurological" nivel, defined as the lowest level that has intact neurological function. If a person has some level below which there is no motor and sensory function, the injury is said to be "completo". Recent evidence suggest that less than 5% of people with "completo" spinal cord injury recover locomotion. A person with an incomplete injury retains some sensation or movement below the level of the injury. The lowest spinal cord level is S4-5, representing the anal sphincter and peri-anal sensation. Así que, if a person is able to contract the anal sphincter voluntarily or is able to feel peri-anal pinprick or touch, the injury is said to be "incomplete". Recent evidence suggest that over 95% of people with "incomplete" spinal cord injury recover some locomotory ability. In addition to a loss of sensation and motor function below the point of injury, individuals with spinal cord injuries will often experience other complications of spinal cord injury: Bowel and bladder function is regulated by the sacral region of the spine, so it is very common to experience dysfunction of the bowel and bladder, including infections of the bladder, and anal incontinence. Sexual function is also associated with the sacral region, and is often affected. Injuries of the C-1, C-2 will often result in a loss of breathing, necessitating mechanical ventilators or phrenic nerve pacing. Inability or reduced ability to regulate heart rate, Presión sanguínea, sweating and hence body temperature. Spasticity (increased reflexes and stiffness of the limbs). Neuropathic pain. Autonomic dysreflexia or abnormal increases in blood pressure, transpiración, and other autonomic responses to pain or sensory disturbances. Atrophy of muscle. Superior Mesenteric Artery Syndrome Osteoporosis (loss of calcium) and bone degeneration. Gallbladder and renal stones. The Location of the Injury Knowing the exact level of the injury on the spinal cord is important when predicting what parts of the body might be affected by paralysis and loss of function. Below is a list of typical effects of spinal cord injury by location (refer to the spinal cord map to the right). Please keep in mind that while the prognosis of complete injuries are predictable, incomplete injuries are very variable and may differ from the descriptions below. Cervical injuries Cervical (cuello) injuries usually result in full or partial tetraplegia (Quadraplegia). Depending on the exact location of the injury, one with a spinal cord injury at the cervical level may retain some amount of function as detailed below, but are otherwise completely paralyzed. C3 vertebrae and above: Typically lose diaphragm function and require a ventilator to breathe. C4: May have some use of biceps and shoulders, but weaker C5: May retain the use of shoulders and biceps, but not of the wrists or hands. C6: Generally retain some wrist control, but no hand function. C7 and T1: Can usually straighten their arms but still may have dexterity problems with the hand and fingers. C7 is generally the level for functional independence. Patients with complete injuries above C7 typically cannot handle activities of daily living and cannot function independently.[cita necesaria] Additional signs and symptoms of cervical injuries include: Inability or reduced ability to regulate heart rate, Presión sanguínea, sweating and hence body temperature. Autonomic dysreflexia or abnormal increases in blood pressure, transpiración, and other autonomic responses to pain or sensory disturbances. Thoracic injuries Injuries at the thoracic level and below result in paraplegia. The hands, armas, head, and breathing are usually not affected. T1 to T8: Most often have control of the hands, but lack control of the abdominal muscles so control of the trunk is difficult or impossible. Effects are less severe the lower the injury. T9 to T12: Allows good trunk and abdominal muscle control, and sitting balance is very good. Lumbar and Sacral injuries The effect of injuries to the lumbar or sacral region of the spinal canal are decreased control of the legs and hips, urinary system, and anus. Central Cord and Other Syndromes uncomplete cord syndromes Central cord syndrome (picture 1) is a form of incomplete spinal cord injury characterized by impairment in the arms and hands and, en menor medida, in the legs. This is also referred to as inverse paraplegia, because the hands and arms are paralyzed while the legs and lower extremities work correctly. Most often the damage is to the cervical or upper thoracic regions of the spinal cord, and characterized by weakness in the arms with relative sparing of the legs with variable sensory loss. This condition is associated with ischemia, hemorrhage, or necrosis involving the central portions of the spinal cord (the large nerve fibers that carry information directly from the cerebral cortex). Corticospinal fibers destined for the legs are spared due to their more external location in the spinal cord. This clinical pattern may emerge during recovery from spinal shock due to prolonged swelling around or near the vertebrae, causing pressures on the cord. The symptoms may be transient or permanent. Anterior cord syndrome (picture 2) is also an incomplete spinal cord injury. Below the injury, motor function, pain sensation, and temperature sensation is lost; touch, propiocepción (sense of position in space), and vibration sense remain intact. Posterior cord syndrome (not pictured) can also occur, but is very rare. Brown-Séquard syndrome (picture 3) usually occurs when the spinal cord is hemisectioned or injured on the lateral side. On the ipsilateral side of the injury (same side), there is a loss of motor function, propiocepción, vibration, and light touch. Contralaterally (opposite side of injury), there is a loss of pain, temperature, and deep touch sensations. Causes Spinal cord injury can occur from many causes, Incluido: Trauma such as Car crashe whiplash, falls, gunshots, diving accidents, war injuries, etc. Tumor such as meningiomas, ependymomas, astrocytomas, and metastatic cancer. Ischemia resulting from occlusion of spinal blood vessels, including dissecting aortic aneurysms, emboli, arteriosclerosis. Developmental disorders, such as spina bifida,etc Neurodegenerative diseases, such as Friedreich's ataxia, spinocerebellar ataxia, etc. Demyelinative diseases, such as Multiple Sclerosis. Transverse myelitis, resulting from spinal cord stroke, inflamación, or other causes. Vascular malformations, such as arteriovenous malformation (AVM), dural arteriovenous fistula (AVF), spinal hemangioma, cavernous angioma and aneurysm. Spinal cord injuries are most often traumatic, caused by lateral bending, dislocation, rotation, axial loading, and hyperflexion or hyperextension of the cord or cauda equina. Motor vehicle accidents are the most common cause of SCIs, while other causes include falls, work-related accidents, sports injuries, and penetrations such as stab or gunshot wounds.[7] SCIs can also be of a non-traumatic origin, as in the case of cancer, infección, intervertebral disc disease, vertebral injury and spinal cord vascular disease.[8] Men are at more risk for spinal cord injury than women.[9][10] It has been observed that more than 80% of the spinal cord injury patients are men.[11] Diagnosis A radiographic evaluation using a x-ray, MRI or CT scan can determine if there is any damage to the spinal cord and where it is located. A neurologic evaluation incorporating sensory testing and reflex testing can help determine the motor function of a person with a SCI.[12][13] Management Modern trauma care includes a step called clearing the cervical spine, where a person with a suspected injury is treated as if they have a spinal injury until that injury is ruled out. The objective is to prevent any further spinal cord damage. People are immobilized at the scene of the injury until it is clear that there is no damage to the highest portions of the spine.[14] This is traditionally done using a device called a long spine board and hard collar. Once at a hospital and immediate life-threatening injuries have been addressed, they are evaluated for spinal injury, typically by x-ray or CT scan. Complications of spinal cord injuries include neurogenic shock, respiratory failure, pulmonary edema, pneumonia, pulmonary emboli and deep venous thrombosis, many of which can be recognized early in treatment and avoided. SCI patients often require extended treatment in an intensive care unit.[15] Techniques of immobilizing the affected areas in the hospital include Gardner-Wells tongs, which can also exert spinal traction to reduce a fracture or dislocation.[16] One experimental treatment, therapeutic hypothermia, is used but there is no evidence that it improves outcomes.[17][18] Maintaining mean arterial blood pressures of at least 85 Para 90 mmHg using intravenous fluids, transfusion, and vasopressors to ensure adequate blood supply to nerves and prevent damage is another treatment with little evidence of effectiveness.[19] Surgery Surgery may also be necessary to remove any bone fragments from the spinal canal and to stabilize the spine.[20] Inflammation can cause further damage to the spinal cord, and patients are sometimes treated with a corticosteroid drug such as methylprednisolone to reduce swelling. The drug is used within 8 hours of the injury.[12] This practice is based on the National Acute Spinal Cord Injury Studies (NASCIS) I and II, though other studies have shown little benefit and concerns about side effects from the drug have changed this practice.[21][22] A food dye, brilliant blue G, has also been shown to have some effect at reducing inflammation after spinal injury.[23][24] Steroids High dose methylprednisolone may improve outcomes if given within 6 hours of injury.[25] Sin embargo, the improvement shown by large trials has been small, and comes at a cost of increased risk of serious infection or sepsis due to the immunosuppressive qualities of high-dose corticosteroids. Rehabilitation Main article: Rehabilitation in spinal cord injury When treating a patient with a SCI, repairing the damage created by injury is the ultimate goal. By using a variety of treatments, greater improvements are achieved, y, por lo tanto, treatment should not be limited to one method. Además, increasing activity will increase his/her chances of recovery.[26] The rehabilitation process following a spinal cord injury typically begins in the acute care setting. Physical therapists, occupational therapists, social workers, psychologists and other health care professionals typically work as a team under the coordination of a physiatrist to decide on goals with the patient and develop a plan of discharge that is appropriate for the patient’s condition. In the acute phase physical therapists focus on the patient’s respiratory status, prevention of indirect complications (such as pressure sores), maintaining range of motion, and keeping available musculature active.[27] Además, there is great emphasis on airway clearance during this stage of recovery.[28] Following a spinal cord injury, the individual’s respiratory muscles become weak and, a su vez, the patient is unable to cough.[29] This results in an accumulation of secretions within the lungs.[29] Physical therapy treatment for airway clearance may include manual percussions and vibrations, postural drainage,[28] respiratory muscle training, and assisted cough techniques.[29] With regards to cough techniques, patients are taught to increase their intra-abdominal pressure by leaning forward to induce cough and clear mild secretions.[29] The quad cough technique is done with the patient lying on their back and the therapist applies pressure on their abdomen in the rhythm of the cough to maximize expiratory flow and mobilize secretions.[29] Manual abdominal compression is another effective technique used to increase expiratory flow which later improves cough.[28] Other techniques used to manage respiratory dysfunction following spinal cord injury include respiratory muscle pacing, abdominal binder, ventilator- assisted speech, and mechanical ventilation.[29] Depending on the Neurological Level of Impairment (NLI), the muscles responsible for expanding the thorax, which facilitate inhalation, may be affected. If the NLI is such that it affects some of the ventilatory muscles, more emphasis will then be placed on the muscles with intact function. Por ejemplo, the intercostal muscles receive their innervation from T1 - T11, and if any are damaged, more emphasis will need to placed on the unaffected muscles which are innervated from higher levels of the CNS. As SCI patients suffer from reduced total lung capacity and tidal volume [30] it is pertinent that physical therapists teach SCI patients accessory breathing techniques (p. ej.. apical breathing, glossopharyngeal breathing, etc.) that typically are not taught to healthy individuals. Outcome measures The Functional Independence Measure (FIM) is an of CD34+ cells and mononuclear cells in the bone marrow of Spinal cord Injury patients of different age groups- A comparative analysis. Bone Marrow Research. ↑ National Institute of Neurological Disorders and Stroke. Spinal Cord Injury: Hope Through Research. URL a la que se accede en 2012-05-18. ↑ Jump up to: 12.0 12.1 Andrew B., MD Peitzman; Andrew B. Peitzman; Miguel, MD Sabom; Donald M., MD Yearly; Timothy C., MD Fabian (2002). The trauma manual, 140–56, Hagerstwon, MD: Lippincott Williams & Wilkins. ↑ Jump up to: 13.0 13.1 (2009) Rosen's Emergency Medicine: Expert Consult, Premium, C. Luis, Missouri: Mosby. ↑ (2002). Cervical spine immobilization before admission to the hospital. Neurocirugía 50 (3 Suppl): S7–17. ↑ (2002). Management of acute spinal cord injuries in an intensive care unit or other monitored setting. Neurocirugía 50 (3 Suppl): S51–7. ↑ PMID 2711238 (PMID 2711238) La cita se completará automáticamente en unos minutos.. Jump the queue or expand by hand ↑ Therapeutic Hypothermia: eMedicine Clinical Procedures. URL a la que se accede en 2011-02-21. ↑ Hypothermia. URL a la que se accede en 2011-02-21. ↑ Neurocirugía. 2002;50(3 Suppl):S58-62. ↑ "Spinal cord injury (SCI)". The Facts On File Encyclopedia of Health and Medicine. Facts On File. ↑ Robert R Hansebout. Acute traumatic spinal cord injury. UpToDate. URL a la que se accede en 2011-09-30. ↑ Steroids in acute spinal cord injury. BestBets. ↑ includeonly>"Food dye 'could minimise severe spinal injury", Daily Express. Retrieved on 2011-02-24.Template:MEDRS ↑ includeonly>"Food dye 'may ease spinal injury'", Noticias de la BBC, 2009-07-28. Retrieved on 2011-02-24.Template:MEDRS ↑ Bracken MB (2012). Steroids for acute spinal cord injury. Cochrane Database Syst Rev 1: CD001046. ↑ (2010). The use of treadmill training to recover locomotor ability in patients with spinal cord injury. Oxford Journals 4: 108–117. ↑ (2007) O'Sullivan S Physical Rehabilitation, 5el, 937–96, Philidelphia Pennsylvania: F.A. Davis. ↑ Jump up to: 28.0 28.1 28.2 Reid, Darlene W, Jennifer A Brown, Kristin J Konnyu, Jennifer M E Rurak, Brodie M Sakakibara, (Octubre 2010). Physiotherapy secretion removal techniques in people with spinal cord injury: A systematic review. The Journal of Spinal Cord Medicine 33 (4). ↑ Jump up to: 29.0 29.1 29.2 29.3 29.4 29.5 Marrón, Robert, Anthony F DiMarco, Jeannette D Hoit, Eric Garshick (Agosto 2006). Respiratory dysfunction and management in spinal cord injury. Respiratory Care 51 (8): 853–870. ↑ (2003). Effect of spinal cord injury on the respiratory system. Am J Phys Med Rehabil 82: 803–814. ↑ Jump up to: 31.0 31.1 31.2 Chumney, D., Nollinger, K., Shesko, K., Skop, K., Spencer, M., & Newton, REAL ACADEMIA DE BELLAS ARTES. (2010). Ability of Functional Independence Measure to accurately predict functional outcome of stroke-specific population: Systematic review. Journal of Rehabilitation Research & Desarrollo 47 (1): 17–30. ↑ Jump up to: 32.0 32.1 32.2 32.3 32.4 Yakura, Joy S.. Recovery following spinal cord injury. American Rehabilitation. URL a la que se accede en 15 Marzo 2011. ↑ Spinal Cord Injury Facts. Foundation for Spinal Cord Injury Prevention, Care & Cure. ↑ Jump up to: 34.0 34.1 Qin W, Bauman WA, Cardozo C (Noviembre 2010). Bone and muscle loss after spinal cord injury: organ interactions. Ann. N. Y. Acad. Sci. 1211: 66–84. ↑ Error on call to template:citar web: Parameters url and title must be specified National Spinal Cord Injury Statistical Center. ↑ Richard A. Spears PhD; Anders Holtz MD PhD (2010). Spinal Cord Injury, Oxford University Press, ESTADOS UNIDOS. ↑ Qiu J (Julio 2009). China Spinal Cord Injury Network: changes from within. Lancet Neurol 8 (7): 606–7. ↑ Knoller N, Auerbach G, Fulga V, et al. (Septiembre 2005). Clinical experience using incubated autologous macrophages as a treatment for complete spinal cord injury: phase I study results. J Neurosurg Spine 3 (3): 173–81. ↑ Cappuccino A, Bisson LJ, Carpenter B, Marzo J, Dietrich WD, Cappuccino H (Enero 2010). The use of systemic hypothermia for the treatment of an acute cervical spinal cord injury in a professional football player. Spine 35 (2): E57–62. ↑ Hansebout RR, Tanner JA, Romero-Sierra C (1984). Current status of spinal cord cooling in the treatment of acute spinal cord injury. Spine 9 (5): 508–11. ↑ Shapiro S, Borgens R, Pascuzzi R, et al. (Enero 2005). Oscillating field stimulation for complete spinal cord injury in humans: a phase 1 trial. J Neurosurg Spine 2 (1): 3–10. ↑ Abraham S (Marzo 2008). Autologous Stem Cell Injections for Spinal Cord Injury - A multicentric Study with 6 month follow up of 108 pacientes. 7th Annual Meeting of Japanese Society of Regenerative Medicine, Nagoya, Japón. ↑ R Ravikumar, S Narayanan and S Abraham (Nov 2007). Autologous stem cells for spinal cord injury. Regenerative Medicine 2 (6): 53–61. ↑ Abraham S (Junio 2007). Autologous Bone Marrow Mononuclear Cells for spinal cord injury- Un informe de caso. Cytotherapy 9 (1). ↑ "FDA Approves a Stem Cell Trial"". Los New York Times. Andrew Pollack. Enero 23, 2009. ↑ Frantz S (2012). Embryonic stem cell pioneer Geron exits field, cuts losses. Nature Biotechnology. ↑ Jump up to: 47.0 47.1 Editorial (2012). Cell Based Therapies: At Crossroads to find the right Cell source. Journal of Stem Cells and Regenerative Medicine. ↑ Iwatsuki K, Yoshimine T, Kishima H, Aoki M, Yoshimura K, Ishihara M, Ohnishi Y, Lima C (Agosto 2008). Transplantation of olfactory mucosa following spinal cord injury promotes recovery in rats. NeuroReport 19 (13): 1249–52. ↑ Fehlings, M. G. and R. Vawda (2011). "Cellular treatments for spinal cord injury: the time is right for clinical trials." Neurotherapeutics 8(4): 704-720. ↑ Dobkin, BH.; Curt, Un.; Guest, J. "Cellular transplants in China: observational study from the largest human experiment in chronic spinal cord injury." Neurorehabilitation and Neural Repair, v. 20 issue 1, 2006, p. 5-13. ↑ C. Ethier, E. R. Oby, M. J. Bauman, L. E. Molinero: Restoration of grasp following paralysis through brain-controlled stimulation of muscles. Naturaleza, Abril 2012. Enlaces externos {{{2}}} at the Open Directory Project Cochrane Injuries Group, systematic reviews on the prevention, treatment and rehabilitation of traumatic injury] Spinal Cord Infarction: Lamination of Fibers Miami Project to Cure Paralysis Noted for experimental cooling protocol used on Kevin Everett United Spinal Association A membership organization dedicated to improving the quality of life of individuals with spinal cord injuries and related disorders. Rehabilitation Research and Training Center (RRTC) on Spinal Cord Injury: Promoting Health and Preventing Complications through Exercise CareCure Forums- Dr. Wise Young's SCI Forum SCI Images - Images of Spinal Cord Injury [3]- Spinal Cord Injury Levels and Classification Spinal Cord Injury Peer Support Patient, Carer and Spouse Support [4] The Spinal Cord Injury Project, W.M. Keck Center for Collaborative Neuroscience at Rutgers University EMSCI Network European Multicenter Study about Spinal Cord Injury Brigham and Women's Hospital Translational Pain Research Clinical trials for pain following SCI Pediatric and Adolescent Spinal Cord Injury Rehabilitation Engineering Research Center on Wheeled Mobility Spinal Cord Injury Forums SCI Support Forums International Institute for Research in Paraplegia Research funding foundation, based in Zurich Spinal Cord Injuries Emergency Medicine for Spinal Cord Injuries Trefethen, Tre. User's Manual for the Paralyzed Penis: Love after spinal cord injury American Sexuality Magazine. Acceder 3-22-07. About Spinal Cord Injury Spinal Cord Injury FAQ for those with SCI, and their families, by Canadian Paraplegic Assocation - Ontario. v·d·e Neurotrauma (S06, Sx4, T09.3–4, 850–854, 950–957) Traumatic brain injury Intracranial hemorrhage/hematoma: intra-axial (Intraparenchymal hemorrhage, Intraventricular hemorrhage)  · extra-axial (Subdural hematoma, Epidural hematoma, Subarachnoid hemorrhage) Brain herniation· Cerebral contusion· Cerebral laceration Concussion: Post-concussion syndrome· Second-impact syndrome· Dementia pugilistica· Chronic traumatic encephalopathy Diffuse axonal injury· Shaken baby syndrome· Penetrating head injury Spinal cord injury Cauda equina syndrome· Paraplegia· Quadriplegia PNS Nerve injury (Peripheral nerve injury), Wallerian degeneration Injury of accessory nerve· Brachial plexus injury· Traumatic neuroma {| clase="navbox plegable nowraplinks" estilo="margen:auto; " [. v]·[. d]·[. e] M: CNS anat (n/s/m/p/4/e/b/d/c/a/f/l/g)/phys/devp noco (m/d/e/h/v/s)/cong/tumr, sysi/epon, injr proc, droga (N1A/2AB/C/3/4/7A/B/C/D) [. v]·[. d]·[. e] M: PNS anat(h/r/t/c/b/l/s/a)/phys(r)/devp/prot/nttr/nttm/ntrp noco/auto/cong/tumr, sysi/epon, injr proc, droga(N1B) |} Nervous system Brain - Spinal cord - Sistema nervioso central - Peripheral nervous system - Somatic nervous system - Autonomic nervous system - Sympathetic nervous system - Parasympathetic nervous system v·d·e Nerves: spinal nerves Cervical (8) anterior (Cervical plexus, Brachial plexus) - posterior (Posterior branches of cervical nerves, Suboccipital, Greater occipital, Third occipital) Thoracic (12) anterior (Intercostal, Intercostobrachial - T2, Thoraco-abdominal nerves - T7-T11, Subcostal - T12) - posterior (Posterior branches of thoracic nerves) Lumbar (5) anterior (Lumbar plexus, Lumbosacral trunk) - posterior (Posterior branches of the lumbar nerves, Superior cluneal L1-L3) Sacral (5) anterior (Sacral plexus) - posterior (Posterior branches of sacral nerves, Medial cluneal nerves) Coccygeal (1) anterior (Coccygeal plexus) - posterior (Posterior branch of coccygeal nerve) Esta página utiliza contenido con licencia Creative Commons de Wikipedia (ver autores).