Download - 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.