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Thread: Silly question about SCI

  1. #11
    When you hear that someone was injured in an accident, had a "broken neck" and died at the scene (or was hung, which often results in a C1-2 fracture), there are two main causes of death. The first is respiratory failure since the diaphragm (the main breathing muscle) is innervated at C3-5. If the injury is at or above C3, and severe, usually respiratory arrest is immediate due to damage to that part of the cord or to the phrenic nerve itself. People like Christopher Reeve would not survive their accident if someone at the scene did not do immediate artificial respiration for them. People with somewhat lower cervical injuries (C4-C8) often can breathe OK on the scene, but due to respiratory fatigue (breathing with just the diaphragm which is often too weak) may end up on a vent temporarily after 1-2 days.

    The second reason, which can occur in really severe injuries, is disruption of both the vertebral arteries. You have two which run through the entire cervical spinal (see diagram) and which join together at the base of the skull to form the basilar artery. This artery is the major blood supply to the brainstem and hind brain, and if cut off entirely, death usually occurs due to anoxia to these parts of the brain very quickly. These areas of the brain also control breathing and regulation of blood pressure.


    If you wring the neck of a bird or other animal, or someone is decapitated you have a combination of both occuring to cause "instant" death.

    The autonomic nervous system regulates heart beat and the smooth muscle of the lungs. This includes the parasympathetic nervous system, which innervates these structures (as well as the gut) through the vagus nerve, which is a cranial nerve that does not travel through the spinal cord. This maintains heart beat and digestion in spite of a spinal cord injury, even a very high one. The sympathetic nerves which also go to these structures do travel down from the brain through the spinal cord and exit in the cervical and thoracic cord. The parasympathetic nervous system (vagus) will slow the heart and increase digestion unless opposed by the sympathetic nerves (which speads up heart rate and slow digestion as well as constrict peripheral arteries to elevate blood pressure). This is the reason that most people with an acute traumatic cervical SCI will have bradycardia (a slow pulse), and low blood pressure (hypotension) for at least a few days to weeks after injury.

    (KLD)
    Last edited by SCI-Nurse; 11-09-2009 at 11:00 PM.

  2. #12
    Quote Originally Posted by MarkB701 View Post
    I have not previously heard of the "brain stem". From your posts this is how the autonomous functions operate. It seems very similar to the spinal column. Is it not the same thing? (clearly not).
    Here are the major divisions of the central nervous system. Note the brainstem is actually the extension of the spinal cord immediately at the top of the spinal cord as it enters the skull. The higher centers of the brain (cerebrum) "wrap" around the brainstem, which is the most primitive part of the brain.



    Here is a schematic diagram of the autonomic nervous system. The medulla oblongata is part of the brainstem. Note that the vagus nerve emerges from there.


    (KLD)

  3. #13
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    I have to agree with SCI for 55 years that there is absolutely NO correlation between injury level and depression. Other factors such as pain, finances, family support, the correct mobility devices and so on all come into play to create a better, fuller life, but the actual level of injury is immaterial. The one friend I had years ago that committed suicide was a low para, and many of us remember Clayton, who from the outside, seemed to have everything going for him in terms of brains, family, and arm function, none of which mattered enough to him. After 43 years it is pain that is my biggest problem, not depression, or whatever depression I may have is directly related to pain, not to my quadness.

  4. #14
    Thanks KLD...! I am considerably more knowledgable having read your posts. It's not cool to be uninformed when I am so closely affected by all this.


    As for risk factors tending towards depression......well, I am very fortunate not to suffer the main ones; no pain, T3, incomplete, financially secure, steady job, happy marriage, good health, happy parents and siblings. Basically, (apart from the SCI) I really lucked out. I am using the good times now to make sure that I am mentally prepared for potentially losing some, or all, of those positive factors at some point in the future....

  5. #15
    Hiyaz
    Some may disagree but this is part of our chat type post blog thing here we all embelish ideas / knowledge
    \Nothing is etched in stone when it comes to these injuries and nothing is etched in stone 100% on anything so I learn from you all and just post my words .

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