disorders of the spinal cord

7/29/2019 Disorders of the Spinal Cord

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Alvin B. Vibar, M.D.


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Vertebral columnVertebrae

cervical 7

thoracic 12

lumbar 5

sacral 5coccygeal 1


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VertebraAnterior segment

Posterior segment

Intervertebral disc


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SPINAL CORD Lies within the vertebral canal and protected by

three surrounding fibrous membranes MENINGES

Held in position by the DENTICULATELIGAMENTS on each side and FILUM TERMINALE

inferiorly SEGMENTED and paired POSTERIOR / SENSORY

and ANTERIOR / MOTOR ROOTS correspondingto each segment of the cord leave the vertebralcanal through the INTERVERTEBRAL FORAMINA

SHORTER than the vertebral column andterminates in the adult at the level oflower borderof first Lumbar vertebra


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Spinal cordGray and white matter

Central canal


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Columns in the White Matter

Posterior funiculus Lateral funiculus Anterior funiculus

Each column is subdivided into tracts.These tracts are:Ascending tractDescending tractIntersegmental tracts


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Parts of the Gray Matter Posterior horn

Lateral horn

Anterior horn

The cell bodies in the gray substanceare grouped into clusters of nuclei oflaminae.


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Laminae of Rexed - groupings Laminae I VI located in the

posterior horn

Lamina VII

located at thelateral horn

Laminae VIII and IX located at theanterior horn

Lamina X

gray substancesurrounding thecentral canal


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Spinal cord with laminae of Rexed


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Ascending Tracts

Dorsal / PosteriorColumnPosition sense2 pt discrimination

Fine, discriminativeVibration senseStereognosis

Spinothalamic tract

ASTT touch / PLSTT pain & temp


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Dermatomes Area of the skin supplied by the

somatosensory fibers from a singlespinal nerve ; useful in localizingthe levels of lesions

C2 back of head C5

tip of shoulder

C6 thumb C7 middle finger C8 small finger T4 T5 nipple T10 umbilicus

L1

inguinal L4 L5 big toe S1 small toe S5 perineum


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Descending Tracts

Lateral corticospinal

Rubrospinal

Lateral reticulospinal

Medial reticulospinal

Vestibulospinal

Tectospinal

Anterior corticospinal


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Spinal CordWhite Matter ofSC

divisible into:

Anterior Funiculus

AnteriorCorticospinalVestibulospinalTectospinal

Reticulospinal

Lateral Funiculus

Lateral Corticospinal

Rubrospinal

Posterior Funiculus


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PYRAMIDAL SYSTEM Providesvoluntary control of skeletal muscles

Owes its name to the pyramidal cells of the primary

motor cortex Consists of:

Corticobulbar

Lateral Corticospinal

Anterior Corticospinal


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CORTICOSPINAL TRACTS LCST

at the lowermedulla,

axons decussate the midlineto enter on the oppositesideof the SC


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Signs of Motor Neuron Lesions

UMNL LMNL

Paralysis Spastic Flaccid

Atrophy (-) (+)Fasciculations (-) (+)

Clonus (+) (-)

PathologicReflexes

(+) (-)

Muscle tone Increased Decreased


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Lesion of Corticospinal TractAbove the level of decussation, manifest

contralaterally

Ex. Stroke involving right motor area of cerebrum left sided paralysis

Below the level of decussation, manifest

ipsilaterally Ex. Spinal cord lesion on right side right sided

paralysis


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Spinal shock Flaccid, areflexic paralysis

Complete loss of sensation

Loss of autonomic function

Loss of reflex activity - paralysis of the bladderand rectum


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Destructive Spinal Cord

SyndromesComplete cord transection

Anterior cord

Central cord

Brown Sequards - Hemisection


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Spinal cord lesions:

Syringomyelia

progressive cavitationaround the central canal; loss of pain &temperature sensations in hands &forearm ( common in cervical)

Poliomyelitis

attacks the anterior horncells leading to LMNL

Tabes Dorsalis caused byneurosyphilis;

dorsal root involvement with secondarydegeneration of dorsal columns ( loss ofvibration and position sense)


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Amyotrophic lateral sclerosispuremotor disease involving the degeneration

of anterior horn cells (LMNL) andcorticospinal tract (UMNL); NO sensoryloss

Subacute combined degeneration

caused by vitamin B12 deficiency;degeneration of posterior and lateralcolumns ( loss of position sense and

vibration in legs associated with UMNL)


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CASE:

A 25 y/o male fell to the ground hittinghis lower back against the gutter when hismotorbike skidded on the wet road.

When he tried to get up, he was unableto move his right leg. He was brought tothe hospital and upon examination, hecould NOT FEEL PAIN on the left side

up to the level of the umbilicus. Hecould NOT FEEL theVIBRATION of thetuning fork on his right foot.


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Brown-Sequards syndrome Spinal Cord Hemisection

Features:

Contralateral loss of pain & temperature

Ipsilateral loss of proprioception

Ipsilateral manifestations of upper and

lower motor neuron lesions


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Diagnosis:Syringomyelia progressive cavitation

around the central canal; loss of pain

& temperature sensations in hands &forearm ( common in cervical)

Dissociated sensory loss


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An 11 y/o girl complained ofpain in the neckand the left shoulder and had a fever of 102 to103 degrees F. A few days later the left arm,forearm and hand were paralyzed; the musclesflaccid. Reflexes in the left upper limb were

absent. Motor control of the other parts of thebody were intact. After 4 weeks, the forearmand the hand could be slightly extended byvoluntary effort, but no other voluntarymovement of these parts could be executed.The paralyzed muscles remained flaccid andshowed marked atrophy.


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Diagnosis:

Poliomyelitis attacks the anterior

horn cells leading to LMNL ;degenerative lesions


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45 / M barangay captain from Cagayan

Hit by an oncoming bus while driving a motorcycle inthe dark No loss of conciousness but was unable to move all

extremities (+) labored breathing On PE, motor strength : 0/5 all extremities 100% sensory deficit from neck downAreflexic all extremities, flaccid, (-) clonus / Babinski Lax sphincter tone on rectal exam


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Diagnosis :

Acute spinal cord injury, complete, C2sensory level, secondary to vehicularaccident


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33 / M farmer from IloiloWas carrying sacks of grain on his back Sudden sharp, stabbing pain from the lower

back radiating to the right leg

On PE, motor strength : 5/5 UE, 4/5 LE , normalmuscle toneDTRs : ++ UE, +++ LE, (-) clonus / BabinskiNo sensory deficitsNormal rectal exam


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Diagnosis : Herniated lumbardisc, L2-L3 level with nerve root compression


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THANK YOU and HAPPY NEW YEAR.

in due time we

shall reap.

if we dont lose

heart.

disorders of the spinal cord

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