Chapter 65: Spinal Cord & Peripheral Nerve Problems

Spinal cord injury represents a devastating condition typically resulting from traumatic mechanisms including motor vehicle accidents, falls, and sports injuries, with pathophysiology involving both primary mechanical damage and secondary injury processes such as ischemia, inflammation, and cellular death. The clinical presentation varies based on injury level and completeness, with cervical injuries potentially causing respiratory compromise, while thoracic and lumbar injuries affect lower extremity function and autonomic processes. Key neurological syndromes include spinal shock characterized by temporary areflexia and flaccid paralysis, neurogenic shock involving cardiovascular instability with hypotension and bradycardia, and autonomic dysreflexia representing a life-threatening hypertensive emergency triggered by noxious stimuli below the injury level. Incomplete injury syndromes such as central cord syndrome, anterior cord syndrome, and Brown-Séquard syndrome produce distinct patterns of motor and sensory deficits that guide prognosis and rehabilitation planning. Management encompasses acute stabilization through spinal immobilization and surgical intervention, prevention of secondary complications including venous thromboembolism and pressure injuries, and comprehensive rehabilitation addressing neurogenic bladder and bowel dysfunction, spasticity management, and psychosocial adaptation. The chapter also addresses spinal cord tumors classified by anatomical location and their progressive neurological effects, cranial nerve disorders including trigeminal neuralgia with its characteristic stabbing facial pain managed through anticonvulsants and surgical interventions, and Bell's palsy presenting as acute unilateral facial paralysis typically treated with corticosteroids and supportive care to optimize recovery outcomes.