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Spinal Shock

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1. Revisit Spinal Shock: Pattern of Reflex Evolution during Spinal Shock (PubMed)

Revisit Spinal Shock: Pattern of Reflex Evolution during Spinal Shock When the spinal cord is suddenly severed, all the fundamental functions of the spinal cord below the level of injury including the spinal cord reflexes are immediately depressed, which is referred to as spinal shock. The resolution of spinal shock occurs over a period of days to months, and spinal shock slowly transitions to spasticity. The definition of spinal shock and the pattern of reflex recovery or evolution remains (...) as an issue of debate and controversy. The identification of clinical signs that determine the duration of spinal shock is controversial. The underlying mechanisms of spinal shock are also not clearly defined. Various authors have defined the termination of spinal shock as the appearance of the bulbocavernosus reflex, the recovery of deep tendon reflexes, or the return of reflexic detrusor activity. However, many questions remain to be answered, such as: When should we define spinal shock as the end? What

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2018 Korean Journal of Neurotrauma

2. Age-related changes in shock absorption capacity of the human spinal column (PubMed)

Age-related changes in shock absorption capacity of the human spinal column The spinal column possesses shock absorption properties, mainly provided by the intervertebral discs. However, with the process of senescence, all structures of the spine, including the discs, undergo degenerative changes. It may lead to alteration of the mechanical properties of the spinal motion segment and diminished capacity for vibration attenuation.The objective of this study was to investigate the age-related (...) changes in shock absorption properties of the spine.A total of 112 individuals divided into three groups according to age (third, fifth, and seventh decades of life) were enrolled in this study. The transmissibility of vibrations through the spine was measured in a standing position on a vibration platform by accelerometers mounted at the levels of S2 and C0. Registered signals were described using four parameters: VMS (variability), peak-to-peak amplitude (PPA), and spectral activity in two bands F2

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2018 Clinical interventions in aging

3. Matrine Directly Activates Extracellular Heat Shock Protein 90, Resulting in Axonal Growth and Functional Recovery in Spinal Cord Injured-Mice (PubMed)

Matrine Directly Activates Extracellular Heat Shock Protein 90, Resulting in Axonal Growth and Functional Recovery in Spinal Cord Injured-Mice After spinal cord injury (SCI), reconstruction of neuronal tracts is very difficult because an inhibitory scar is formed at the lesion site, in which several axonal growth inhibitors, such as chondroitin sulfate proteoglycans (CSPG), accumulate. We previously found that matrine, a major alkaloid in Sophora flavescens, enhanced axonal growth in neurons (...) seeded on CSPG coating. The aims of this study were to investigate therapeutic effects of matrine in SCI mice and to clarify the underlying mechanism. Matrine was orally administered to contusion SCI mice. In the matrine-treated mice, motor dysfunction of the hindlimbs was improved, and the density of 5-HT-positive tracts was increased in the injured spinal cord. We explored putative direct binding proteins of matrine in cultured neurons using drug affinity responsive target stability (DARTS

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2018 Frontiers in pharmacology

4. Heat shock proteins are differentially expressed in brain and spinal cord: implications for multiple sclerosis (PubMed)

Heat shock proteins are differentially expressed in brain and spinal cord: implications for multiple sclerosis Multiple sclerosis (MS) is a chronic neurodegenerative disease characterized by demyelination, inflammation and neurodegeneration throughout the central nervous system. Although spinal cord pathology is an important factor contributing to disease progression, few studies have examined MS lesions in the spinal cord and how they differ from brain lesions. In this study we have compared (...) brain and spinal cord white (WM) and grey (GM) matter from MS and control tissues, focusing on small heat shock proteins (HSPB) and HSP16.2. Western blotting was used to examine protein levels of HSPB1, HSPB5, HSPB6, HSPB8 and HSP16.2 in brain and spinal cord from MS and age-matched non-neurological controls. Immunohistochemistry was used to examine expression of the HSPs in MS spinal cord lesions and controls. Expression levels were quantified using ImageJ. Western blotting revealed significantly

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2018 Clinical and experimental immunology

5. Detection of local and remote cellular damage caused by spinal cord and peripheral nerve injury using a heat shock signaling reporter system (PubMed)

Detection of local and remote cellular damage caused by spinal cord and peripheral nerve injury using a heat shock signaling reporter system Spinal cord and peripheral nerve injury results in extensive damage to the locally injured cells as well as distant cells that are functionally connected to them. Both primary and secondary damage can cause a broad range of clinical abnormalities, including neuropathic pain and cognitive and memory dysfunction. However, the mechanisms underlying (...) these abnormalities remain unclear, awaiting new methods to identify affected cells to enable examination of their molecular, cellular and physiological characteristics. Here, we report that both primary and secondary damage to cells in mouse models of spinal cord and peripheral nerve injury can be detected in vivo using a novel fluorescent reporter system based on the immediate stress response via activation of Heat Shock Factor 1. We also provide evidence for altered electrophysiological properties of reporter

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2018 IBRO Reports

6. Shock

and tongue swelling urticarial rash pelvic pain/vaginal bleeding in woman of childbearing age increasing age comorbidities myocardial infarction cardiomyopathy heart valve disease arrhythmias trauma gastrointestinal bleeding ruptured abdominal aortic aneurysm burns/heat stroke gastrointestinal losses: diarrhoea and vomiting pancreatitis sepsis anaphylaxis/poisoning spinal or brainstem injury endocrine disease pulmonary embolism cardiac tamponade new medicine (anaphylactic shock) Diagnostic investigations (...) Shock Shock - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search  Shock Last reviewed: February 2019 Last updated: January 2019 Summary Commonly diagnosed when signs of hypoperfusion are associated with low or declining blood pressure. It may result from a number of disease processes, including pump failure (cardiogenic), loss of intravascular volume (hypovolaemic), failure of vasoregulation (distributive), or obstruction

2019 BMJ Best Practice

7. Induction of Endogenous Neural Stem Cells by Extracorporeal Shock Waves after Spinal Cord Injury. (PubMed)

Induction of Endogenous Neural Stem Cells by Extracorporeal Shock Waves after Spinal Cord Injury. Animal experimental study OBJECTIVES.: The purpose of this study is to investigate the effects of extracorporeal shock waves (ESWs) on endogenous neural stem cells (NSCs) proliferation after spinal cord injury (SCI).Exogenous stem cell transplantation for SCI still has many limitations to be addressed such as ideal cell sources, timing of transplantation, and fate of the transplanted cells

2017 Spine

8. Spinal Cord Infarction in the Course of a Septic Shock: About One Case and Review of the Literature (PubMed)

Spinal Cord Infarction in the Course of a Septic Shock: About One Case and Review of the Literature We report the case of a patient admitted to our intensive care unit in the course of a septic shock, secondary to cholangitis. After rapid hemodynamic stabilization, antibiotherapy, and endoscopic extraction of bile ducts stones, she appeared to have developed flaccid paraplegia. The suspected diagnosis of medullar ischemia was confirmed by typical MRI findings. This case stresses the potential

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2017 Case reports in critical care

9. Shock

and tongue swelling urticarial rash pelvic pain/vaginal bleeding in woman of childbearing age increasing age comorbidities myocardial infarction cardiomyopathy heart valve disease arrhythmias trauma gastrointestinal bleeding ruptured abdominal aortic aneurysm burns/heat stroke gastrointestinal losses: diarrhoea and vomiting pancreatitis sepsis anaphylaxis/poisoning spinal or brainstem injury endocrine disease pulmonary embolism cardiac tamponade new medicine (anaphylactic shock) Diagnostic investigations (...) Shock Shock - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search  Shock Last reviewed: February 2019 Last updated: January 2019 Summary Commonly diagnosed when signs of hypoperfusion are associated with low or declining blood pressure. It may result from a number of disease processes, including pump failure (cardiogenic), loss of intravascular volume (hypovolaemic), failure of vasoregulation (distributive), or obstruction

2018 BMJ Best Practice

10. CRACKCast E197 – Shock

to the process. [5] What is neurogenic shock, and how does it differ from spinal shock? Neurogenic shock = interrupted sympathetic and parasympathetic input from spinal cord to heart and vasculature. Classically – vasodilation and bradycardia (but can have a wide variation in heart rate depending on other factors). Spinal shock = loss of sensation and motor function following spinal cord injury. reflexes are depressed or absent distal to site of injury. This may last for hours to weeks post-injury. The end (...) of spinal shock is marked by the return of the bulbocavernosus reflex (internal/external anal sphincter contraction in response to squeezing the glans penis or clitoris, or tugging on an indwelling foley). Never checked one of them before. [6] What are the empirical criteria for the diagnosis of circulatory shock? (Box 6.2) Why do we care: ED patients presenting with shock often have no obvious cause. We need to key on key elements of the history/exam to make a diagnosis and start appropriate management

2019 CandiEM

11. Effect of low-energy extracorporeal shock wave on vascular regeneration after spinal cord injury and the recovery of motor function (PubMed)

Effect of low-energy extracorporeal shock wave on vascular regeneration after spinal cord injury and the recovery of motor function Latest studies show that low-energy extracorporeal shock wave therapy (ESWT) can upregulate levels of vascular endothelial growth factor (VEGF). VEGF can ease nervous tissue harm after spinal cord injury (SCI). This study aims to explore whether low-energy ESWT can promote expression of VEGF, protect nervous tissue after SCI, and improve motor function.Ninety adult (...) female rats were divided into the following groups: Group A (simple laminectomy), Group B (laminectomy and low-energy ESWT), Group C (spinal cord injury), and Group D (spinal cord injury and low-energy ESWT). Impinger was used to cause thoracic spinal cord injury. Low-energy ESWT was applied as treatment after injury three times a week, for 3 weeks. After SCI, the Basso, Beattie, and Bresnahan (BBB) scale was used to evaluate motor function over a period of 42 days at different time points

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2016 Neuropsychiatric disease and treatment

12. Effect of low-energy extracorporeal shock wave on vascular regeneration after spinal cord injury and the recovery of motor function [Retraction] (PubMed)

Effect of low-energy extracorporeal shock wave on vascular regeneration after spinal cord injury and the recovery of motor function [Retraction] [This retracts the article on p. 2189 in vol. 12, PMID: 27621630.].

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2016 Neuropsychiatric disease and treatment

13. Spinal Shock

Spinal Shock Spinal Shock Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Spinal Shock Spinal Shock Aka: Spinal Shock From Related (...) Chapters II. Pathophysiology Temporary (<24 hours) Muscle tone loss ( ) and loss after spinal cord injury Spinal " " is a misnomer as it refers to a "shock" to the spinal nerves, not a true shock syndrome Contrast with , which is a distributive shock from sympathetic dysfunction Incomplete spinal cord injury may mimic complete injury when Spinal Shock is present III. Signs (S2-S4) is absent in Spinal Shock and present in severed spinal cord Anal sphincter contraction in response to one of following

2018 FP Notebook

14. Spinal cord compression

of symptoms back pain numbness or paraesthesias weakness or paralysis bladder or bowel dysfunction hyper-reflexia sensory loss muscle weakness or wasting loss of tone below level of suspected injury (spinal shock) hypotension and bradycardia (neurogenic shock) complete cord transection syndrome cauda equina syndrome central cord syndrome history of malignancy immunosuppression intravenous drug use loss of rectal sphincter reflex loss of appendicular reflexes local deformity of spine on palpation Brown (...) Spinal cord compression Spinal cord compression - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search  Spinal cord compression Last reviewed: February 2019 Last updated: August 2018 Summary Can occur as a result of spine trauma, vertebral compression fracture, intervertebral disc herniation, primary or metastatic spinal tumour, or infection. The resulting spinal cord injury may be acute, sub-acute, or chronic and occurs due

2018 BMJ Best Practice

15. Shock

/ spinal injuries • fainting. 2.4 Blockage of blood flow in or out of heart (obstructive shock), e.g.: • tension pneumothorax • cardiac tamponade ANZCOR Guideline 9.2.3 January 2016 Page 2 of 3 • pulmonary embolus • in pregnancy, compression of large abdominal blood vessels by the uterus. 3 Recognition The symptoms, signs and rate of onset of shock will vary widely depending on the nature and severity of the underlying cause 3 . Shock is a condition that may be difficult to identify. 3.1 Symptoms may (...) Shock ANZCOR Guideline 9.2.3 January 2016 Page 1 of 3 ANZCOR Guideline 9.2.3 – Shock Guideline Who does this guideline apply to? This guideline applies to adult, child and infant victims. Who is the audience for this guideline? This guideline is for use by bystanders, first aiders and first aid providers. 1 Introduction Shock is a loss of effective circulation resulting in impaired tissue oxygen and nutrient delivery 1 and causes life threatening organ failure. 2 Causes Some conditions which

2016 Australian Resuscitation Council

16. CRACKCast E006 – Shock in the ER

is often life threatening if not treated urgently (SEVERE form of an allergic reaction) Central Neurogenic Shock this is NOT the same as spinal shock (more to come in future episodes) usually a diagnosis of EXCLUSION caused by an injury to the cervical or thoracic vertebrae causing peripheral sympathetic denervation look for the classic TRIAD : hypotension, bradycardia, and warm extremities Drug Overdose Due to a sympatholytic or sedative drug e.g. clonidine, TCA, mixed narcotic/benzo Adrenal Crisis (...) CRACKCast E006 – Shock in the ER CRACKCast E006 - Shock in the ER - CanadiEM CRACKCast E006 – Shock in the ER In , by Adam Thomas September 22, 2016 This episode of CRACKCast cover’s Rosen’s Chapter 06, Shock. Shock is a common event in the ER and a good understanding of how to recognize and treat it is essential for ER docs. Shownotes – Rosen’s in Perspective: What is SHOCK? “a transition between life and death” mitochondria are first to be affected in shock The “canaries in the coalmine

2016 CandiEM

17. CRACKCast E106 – Spinal Cord

they are mediated by the spinal levels; examples would be: DTR’s Autonomic dysfunction: Neurogenic shock Priapism If you have a bulbocavernosus reflex = spinal shock is over; if you don’t have a BC reflex the spinal injury has likely led to spinal shock. “Spinal shock refers to the loss of muscle tone and reflexes with complete cord syndrome during the acute phase of injury. Spinal shock typically lasts less than 24 hours but has been reported occasionally to last days to weeks. A marker of spinal shock is loss (...) of the bulbocavernosus reflex, which is a normal cord-mediated reflex that may be preserved in complete cord lesions. The bulbo-cavernosus reflex involves involuntary reflex contraction of the anal sphincter in response to a squeeze of the glans penis or a tug on the Foley catheter. The termination of the spinal shock phase of injury is heralded by the return of the bulbocavernosus reflex; increased muscle tone and hyperreflexia follow later.” – Rosen’s 9 th Edition, Chapter 96 [4] Describe 3 common partial cord

2017 CandiEM

18. Management of Suspected Spinal Injury

the limbs (paralysis) • nausea • headache or dizziness • altered or absent skin sensation. 2.2 Signs Signs of spinal injury include: • head or neck in an abnormal position • signs of an associated head injury • altered conscious state • breathing difficulties • shock • change in muscle tone, either flaccid or stiff • loss of function in limbs • loss of bladder or bowel control • priapism (erection in males). ANZCOR Guideline 9.1.6 January 2016 Page 3 of 6 3 Management The priorities of management (...) Management of Suspected Spinal Injury ANZCOR Guideline 9.1.6 January 2016 Page 1 of 6 ANZCOR Guideline 9.1.6 – Management of Suspected Spinal Injury Guideline Who does this guideline apply to? This guideline applies to adult, child and infant victims. Who is the audience for this guideline? This guideline is for use by bystanders, first aiders and first aid providers. This guideline is equally applicable to healthcare professionals working in the pre-hospital setting. 1 Introduction The spine

2016 Australian Resuscitation Council

19. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock Surviving Sepsis Campaign: International Guidelines for Man... : Critical Care Medicine You may be trying to access this site from a secured browser on the server. Please enable scripts and reload this page. Login No user account? Lippincott Journals Subscribers , use your username or email along with your password to log in. Remember me on this computer Register for a free account Registered users can (...) /CCM.0000000000002255 Special Article Free Objective: To provide an update to “ Surviving Sepsis Campaign Guidelines for Management of Sepsis and Septic Shock : 2012.” Design: A consensus committee of 55 international experts representing 25 international organizations was convened. Nominal groups were assembled at key international meetings (for those committee members attending the conference). A formal conflict-of-interest (COI) policy was developed at the onset of the process and enforced

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2016 European Respiratory Society

20. Severe bilateral optic nerve and retinal hypoperfusion in a patient with acute respiratory distress syndrome and septic shock (PubMed)

Severe bilateral optic nerve and retinal hypoperfusion in a patient with acute respiratory distress syndrome and septic shock To report a case of bilateral central retinal artery occlusion with both anterior and posterior ischemic optic neuropathy.A 65-year-old Caucasian woman presented with acute respiratory distress syndrome and septic shock. After treatment with vasopressors and prolonged prone positioning, she was noted to be bilaterally completely blind on hospitalization day 12 (...) . Evaluation revealed evidence of bilateral central retinal artery occlusion and bilateral ischemic optic neuropathy. Magnetic resonance imaging of the orbits demonstrated severe restricted diffusion of both optic nerves consistent with ischemia. Both central retinal artery occlusion and ischemic optic neuropathy have been reported in cases of severe hypotension, blood loss, and prone positioning, most often postoperatively after spinal surgery.To our knowledge, this is the first reported case of bilateral

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2017 American journal of ophthalmology case reports

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