Question 1: Spinal Injury and Nystagmus

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Question 1 Spinal Injury and Nystagmus

• Once upon a time, there was a logger named Jimbo
  who slipped and fell on a stump striking his
  head, neck and arm. He complained to his boss of
  dizziness, headache, and a sore arm, his boss
  noticed his eyes were jerking back and forth. On
  the way to the hospital his neck was not
  immobilized and he kept moving it around. Jimbo
  died the next day from a broken neck.

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How and why did his injury produce nystagmus, and
why did he die the day after vs. immediately ?
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Nystagmus

• What is it? Constant, involuntary, cyclical
  movement of the eyeball due to a disease or
  injury in the CNS. These movements may be in both
  eyes or just one, sometimes called dancing eyes
• Congenital a condition that one is born with.
  It is the most common form of nystagmus that is
  usually not very severe
• Acquired results from traumatic injury to the
  head and more specifically

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What Nystagmus Looks Like
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What actually happens

• the semicircular canals of the vestibular
  apparatus help maintain balance
• within the canals are hair cells that when
  stimulated cause depolarization or
  hyperpolarization, depending on direction of
  stimulus
• suspended in the gelatinous fluid are little
  calcium carbonate rocks called otholiths whose
  function is to add inertia to the fluid
• traumatic head injury can cause one of these
  otholiths to break lose and remain on the hair
  cell causing continual stimulation

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Spinal Cord Injuries

• causes motor vehicle accidents, falls, sports
  injuries (diving in shallow water), industrial
  accidents and many others, rheumatoid arthritis
  and osteoporosis can weaken spine

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How Did Jimbo Die?

• Neck injury caused by the fall broke his neck
  and damaged his spinal cord
• immediately following blunt trauma a hemorrhage
  develops in the central gray matter
• the hemorrhaged area and edema can spread from
  the central area to the entire diameter of the
  spinal cord within 6 to 24 hours

• Edema compresses the nerve conduction in the
  fiber tracts which are protected by the C3-C5
  vertebrae
• This portion of the cord controls breathing by
  sending efferent messages to the target muscles
  (intercostals and diaphragm)

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Level of Spinal Chord Injury

• Injury at or above 5th cervical vertebra
  breathing may be affected and the person may die
  from asphyxiation
• Damage below C6 paralysis may occur, but
  breathing is left intact

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Preventing More Extensive Injury

• If a head injury occurs watch out for
• NYSTAGMUS
• Watch for three major concerns
• Protection against shock
• Maintenance of ventilation
• 3) Neck immobilization to prevent further spinal
  cord damage, unrestricted movement of the neck
  risks converting a partial injury to a complete
  one