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SPINAL CORD
VERTEBRAL LEVEL
From cervical segments- subtract 1 From upper thoracic segments- subtract 2 From lower thoracic segments- subtract 3 Lumbar 1-2 segments- T10 vertebra Lumbar 3-4 segments- T11 vertebra Lumbar 5 segments- T12 vertebra
SPINAL SHOCK is the phenomena surrounding transection of the spinal
cord that leads to temporary loss or depression of all or most spinal reflex activity below the level of a spinal lesion.
the period of spinal shock can last from hours to 6 weeks.
In the acute stage, there will be hypotonic paralysis, areflexia, loss of sensory function and dysautonomia. Patient shows retention of the bladder due to the impaired reflex of emptying the bladder.
In post acute stage, first autonomic reflexes come to normal.
In the chronic stage, there will be hypertonic paralysis, hyper-reflexia, spastic-reflex bladder. Patient at this stage shows incontinence.
Causes of flaccid paralysis
Anterior horn cells-poliomyelitis
Nerve root- radiculitis cauda equina
Peripheral nerves- GB syndrome,peripheral neuropathy
Myoneural junction- myasthenia gravis
Muscles – myopathy
hysterical
Causes of spastic paraplegia
CompressiveExtraduralPott`s diseaseMetastatic carcinoma
from breast, lung prostate
Multiple myelomaHerniated disc , fractureCervical spondylosis
IntraduralMeningioma ,
lymphoma ,metsEpidural abscessIntramedullarySpinal cord tumor
VascularArteriovenous malformationAntiphospholipid syndrome and other
hypercoagulable states InflammatoryMultiple sclerosis Transverse myelitisSarcoidosisVasculitis
Infectious Viral: HZV, HSV-1 and -2, CMV, HIVBacterial and mycobacterial: Listeria, syphilis, Mycoplasma pneumoniaeParasitic: schistosomiasis, toxoplasmosis MetabolicVitamin B12 deficiency (subacute combined
degeneration)
Syringomyelia
Trauma Tumour Tuberculosis Thrombosis Transverse myelitis
Differences between compressive and non compressive paraplegia
COMPRESSIVE NONCOMPRESSIVE
Bony changes Root pains Upper level of
sensory loss present
Zone of hyperesthesia may be present
No bony changes No root pains No definite level
Absent
Usually gradual onset
Asymmetrical involvement of limbs
Bladder bowel disturbance occurs
Usually acute onset
Symmetrical involvement of limbs
Occurs but late
Compressive Non compressive
Symptoms Intra medullary Extra medullary
Radicular pain nil common
Funicular pain common Less common
Vertebral pain unusual common
UMN signs late early
LMN signs Prominent and diffuse Unusual /segmental
Sensory involvement progression
Descending Ascending
Sphincter involvement Early Late
Trophic changes Common Unusual
Dissociated sensory loss Yes No
Sacral sensation Spared Lost
Transverse myelitis
Inflammation of the spinal cord at a single level. Symptoms develop rapidly and include limb weakness, sensory disturbance, bowel and bladder disturbance, back pain, and radicular pain. Recovery generally begins within 3mo. but is not always complete.
Causes: Idiopathic (thought to be autoimmune mechanism) Infection Vaccination Autoimmune disease e.g. SLE, sarcoidosis MS Malignancy Vascular e.g. thrombosis of spinal arteries, vasculitis 2° to
heroin abuse, spinal A-V malformation
Investigation MRI shows swelling of spinal cord Management Methylprednisolone injection followed by
oral prednisoloneGood recovery occur in 30% of cases
Spinal cord infarction
Anterior spinal artery infarction produces paraplegia or quadriplegia, sensory loss affecting pain/temperature but sparing vibration/position sensations (supplied by posterior spinal arteries), and loss of sphincter control.
Onset sudden or evolving over minutes or a few hours.
Associated conditions: aortic atherosclerosis, dissecting aortic aneurysm, hypotension.
Therapy is directed at the predisposing condition.
Subacute combined degeneration (vitamin B12 deficiency)
Paresthesia in hands and feet, early loss of vibration/position sense, progressive spastic/ataxic weakness, and areflexia due to associated peripheral neuropathy; mental changes and optic atrophy may be present. Diagnosis is confirmed by a low serum B12 level and a positive Schilling test. Treatment is vitamin replacement.
Hereditary spastic paraparesis
Isolated progressive paraparesis runs in some families. Inheritance is variable. Additional features including cerebellar signs, wasted hands and optic atrophy are sometimes seen. The paraparesis is usually mild and progresses slowly over many years. Some cases have dystonic features and respond to levodopa.
Syringomyelia
Tubular cavities (syrinxes) form close to the central canal of the spinal cord. As the syrinx expands, it compresses nerves within the spinal cord. Typically presents with wasting and weakness of hands and arms, and loss of temperature and pain sensation over trunk and arms (cape distribution)..
COMPLICATION
Skin care issues (Pressure sores) DVT Loss of bladder control & UTI Loss of bowel control Loss of sensory function Loss of motor function Depression
TREATMENT
Based on etiology Compressive – decompressive surgery ATM – steroids Supportive care Physiotherapy