What is quadriplegia?

Causes and Symptoms

Quadriplegia may result from spinal cord injury, especially in the area of the fifth to seventh cervical vertebrae. Such injury usually follows trauma or vertebral pressure on the soft tissue of the cord. Damage causes flaccidity in the arms and legs, as well as loss of power and sensation below the level of injury. Spinal cord injuries above the fifth cervical vertebra dramatically affect other body systems as well.

For example, cardiovascular complications result from a block in the sympathetic nervous system that allows the parasympathetic system to dominate. One possible complication is hypotension (blood pressure below 90/60) resulting from vasodilation, which allows blood to pool in the veins of the extremities and thereby slows the venous blood return to the heart. Another complication is low body temperature (96 degrees Fahrenheit or lower) from the inability of blood vessels to constrict efficiently, allowing constant close blood vessel contact with the body surface and consequent heat loss. Bradycardia (slow heart rate) may occur from stimulation of the heart by the vagus nerve and absence of the inhibiting effects of the sympathetic system. A decrease in peristalsis, the movement of food through the gastrointestinal system, results from various types of shock. Respiratory complications, a major cause of death, may occur from damage to the upper cervical cord. Autonomic dysreflexia may occur in injuries above the fourth thoracic vertebra, in which a severed connection between the brain and the spinal cord produces an exaggerated autonomic response to such stimuli as distended bladder, fecal impaction, infection, decubitus ulcers, or surgical manipulation. The key symptom of autonomic dysreflexia is hypertension (high blood pressure).

A complete physical and neurologic examination must assess remaining motor function and determine if the cord injury is complete or partial. Detailed information about the trauma may help health care providers anticipate other related injuries. Computed tomography (CT) scans can identify fractures, dislocations, subluxation, and blockage in the spinal cord. X-rays of the head, chest, and abdomen can rule out underlying injuries. Since this type of injury has such far-reaching physiologic effects, significant laboratory data assessing respiratory, hepatic (liver), and pancreatic functions are necessary to provide a baseline.

Treatment and Therapy

The treatment of quadriplegia begins at the scene of the accident, with immobilization of the neck and spine. At the hospital, methods of immobilization include insertion of Gardner Wells tongs or halo traction. A turning frame helps prevent pulmonary complications such as atelectasis (partial lung collapse), pneumonia, and pulmonary embolism; cardiovascular complications such as blood clot formation and orthostatic hypotension; and other complications such as kidney stones, muscle atrophy, decubitus ulcers, and infections.

After stabilization, therapy consists of steroids, intravenous glycopyrrolate to maintain the integrity of the gastrointestinal tract, insertion of a Foley catheter, and administration of a potent diuretic such as mannitol. This treatment regimen is followed for ten days to decrease spinal cord edema (swelling). Unchecked edema further compromises the blood supply to sensitive cord tissue, producing irreversible cord damage. Prevention of ascending cord edema preserves higher cord segments and maximum function in the upper extremities. Each cord segment preserved means greater potential for rehabilitation.

After ten days of therapy, surgical fusion stabilizes the unstable spine. Surgery must also remove bone fragments that can irritate the spinal cord and, in later stages, aggravate spasticity. Another necessary part of treatment is aggressive respiratory therapy that, in the intubated patient, includes instillation of three to five milliliters of normal saline solution and bagging the patient before thorough suctioning to remove secretions and prevent mucus plugs. In cervical cord injuries above the fifth vertebra, intubation and ventilator assistance are always necessary.

Bibliography

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Christopher and Dana Reeve Foundation. "Paralysis Resource Center." Christopher and Dana Reeve Foundation, 2013.

Mayo Clinic. "Spinal Cord Injury." Mayo Clinic, October 22, 2011.

MedlinePlus. "Paralysis." MedlinePlus, August 9, 2013.

Rowland, Lewis P., ed. Merritt’s Textbook of Neurology. 12th ed. Philadelphia: Lippincott Williams & Wilkins, 2010.

Smith, Nathalie. "Quadriplegia and Paraplegia." Health Library, March 15, 2013.

Victor, Maurice, and Allan H. Ropper. Adams and Victor’s Principles of Neurology. 9th ed. New York: McGraw-Hill, 2009.