Cns 7


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Cns 7

  1. 1. Spinal Cord Injury
  2. 2. Causes <ul><li>1. Motor vehicle accidents </li></ul><ul><li>2. Falls, violence, sport injuries (diving) </li></ul>
  3. 3. Sites of Pathology: Most common areas of involvement <ul><li>1. Cervical (C1, C2, C4 - C6) </li></ul><ul><li>2. T 11 to L2 </li></ul>
  4. 4. Classifications <ul><li>Complete SCI: motor and sensory neural pathways are completely transected resulting in total loss of motor and sensory function below level of injury </li></ul><ul><li>Incomplete SCI: motor and sensory neural pathways are only partially interrupted resulting with variable loss of function below level of injury function below level of injury </li></ul>
  5. 5. Classifications <ul><li>Cause of injury: specific as to trauma </li></ul><ul><li>Level of injury: area of spinal cord affected </li></ul>
  6. 6. Complete Transection of spinal cord <ul><li>I Spinal Shock </li></ul><ul><li>Temporary loss of reflex function (areflexia) below level of injury beginning immediately after complete transection of spinal cord </li></ul>
  7. 7. Manifestations <ul><li>1. Hypotension </li></ul><ul><li>2. Flaccid paralysis of skeletal muscles distal to injury </li></ul><ul><li>3. Loss of all sensation of distal to injury </li></ul><ul><li>4. Absence of visceral and somatic sensations </li></ul><ul><li>Bladder and bowel dysfunction </li></ul><ul><li>6. Loss of ability to perspire </li></ul>
  8. 8. II. Stage of recovery of reflex activity <ul><li>Spinal shock begins within hour of injury and lasts from few minutes up to several months; ends with return of reflex activity: hyperreflexia, muscle spasticity, reflex bladder emptying </li></ul>
  9. 9. Stage of reflex activity <ul><li>1. Autonomic reflexes </li></ul><ul><li>2. Muscle tone </li></ul><ul><li>3. Reflex movements </li></ul><ul><li>Flexor reflex </li></ul><ul><li>Mass reflex </li></ul><ul><li>Deep reflexes </li></ul><ul><li>Coitus reflex </li></ul>
  10. 10. Manifestations <ul><li>Mass reflex </li></ul><ul><li>Scratching the skin of the lower limbs produces a widespread reaction due to irradiation between the spinal centers. </li></ul><ul><li>Flexor spasm </li></ul><ul><li>Contraction of abdominal muscles </li></ul><ul><li>Evacuation of bladder , sweating etc </li></ul>
  11. 11. III stage of reflex failure <ul><li>Severe infections </li></ul><ul><li>Toxaemia </li></ul>
  12. 12. Degree of Injury <ul><ul><li>Complete transection </li></ul></ul><ul><ul><ul><li>Total paralysis and loss of sensory and motor function although arms or rarely completely paralyzed </li></ul></ul></ul><ul><ul><li>Incomplete (partial transection) </li></ul></ul><ul><ul><ul><li>Mixed loss of voluntary motor activity and sensation </li></ul></ul></ul>
  13. 13. Incomplete cord section <ul><li>Stage of spinal shock </li></ul><ul><li>Stage of reflex activity </li></ul><ul><li>- Paraplegia of extension </li></ul><ul><li>- Associated with exaggerated tendon reflex, positive supporting reflex, flexion withdrawal reflex , phillipson’s reflex, no mass reflex </li></ul><ul><li>Stage of reflex failure </li></ul>
  14. 14. Incomplete cord patterns <ul><ul><li>Central cord syndrome: More common in older people </li></ul></ul><ul><ul><ul><li>Frequently from hyperextension of spine </li></ul></ul></ul><ul><ul><ul><li>Weakness in upper and lower ext, but greater in upper. </li></ul></ul></ul><ul><ul><li>Anterior cord syndrome </li></ul></ul><ul><ul><li>Posterior cord syndrome </li></ul></ul><ul><ul><li>Brown-Sequard syndrome </li></ul></ul>
  15. 16. Anterior Cord Syndrome <ul><li>Caused by pressure on paired anterior spinal arteries or damage by bony fragments </li></ul><ul><li>Damage: spinothalamic tracts </li></ul><ul><li>corticospinal tracts </li></ul>B B
  16. 17. Anterior cord syndrome <ul><ul><li>Compression of the ant. Cord, usually a flexion injury </li></ul></ul><ul><ul><li>Sudden, complete motor paralysis at lesion and below; decreased sensation (including pain) and loss of temperature sensation below site. </li></ul></ul><ul><ul><li>Touch, position, vibration and motion remain intact. </li></ul></ul>
  17. 19. Posterior Cord Syndrome <ul><li>Rare </li></ul><ul><li>Damage to corticospinal tracts and posterior columns. </li></ul>
  18. 20. Posterior cord syndrome <ul><li>Assoc with cervical hyperextension injuries </li></ul><ul><li>Dorsal area of cord is damaged resulting in loss of proprioception </li></ul><ul><li>Pain, temperature sensation and motor function remain intact. </li></ul>
  19. 22. Central Cord Syndrome <ul><li>Most common incomplete cord lesion </li></ul><ul><li>Bimodal distribution </li></ul><ul><li>Spondylosis and trauma major causative agents </li></ul><ul><li>Mechanism - hyperextension of the cervical cord </li></ul>
  20. 23. Characteristics (cont.) <ul><li>Damage: </li></ul><ul><ul><li>Central spinothalamic tracts </li></ul></ul><ul><ul><li>Central corticospinal tracts </li></ul></ul><ul><ul><li>Upper extremities </li></ul></ul><ul><ul><li>greater than lower </li></ul></ul>
  21. 24. Characteristics (cont.) <ul><li>Result: </li></ul><ul><ul><li>Loss of motor function, much more profound in upper extremities, particularly distally </li></ul></ul><ul><ul><li>Loss of pain and temperature sensation upper extremities, distally </li></ul></ul>B B
  22. 25. Brown-Sequard syndrome <ul><li>Damage to one half of the cord on either side. </li></ul><ul><li>Caused by penetrating trauma or ruptured disk. ischemia (obstruction of a blood vessel), or infectious or inflammatory diseases such as tuberculosis, or multiple sclerosis. BSS may be caused by a spinal cord tumor, trauma (such as a puncture wound to the neck or back),. </li></ul><ul><li>a rare SCI syndrome which results in-Below the lesion </li></ul><ul><ul><li>On same side : weakness or paralysis (hemiparaplegia) with little sensory loss </li></ul></ul><ul><ul><li>On opposite side: a loss of sensation (hemianesthesia) with little motor loss </li></ul></ul>
  23. 26. Brown-Sequard Syndrome <ul><li>Results: isolated loss of all functions </li></ul><ul><ul><li>Motor – same side as damage </li></ul></ul><ul><ul><li>Motion, position, vibration – same side as the damage </li></ul></ul><ul><ul><li>Pain and temperature – opposite side as the damage </li></ul></ul>
  24. 28. Tabes dorsalis <ul><li>Neurosyphilis </li></ul><ul><li>Degeneration of posterior root up to DRG. </li></ul><ul><li>Loss of pain sensations </li></ul><ul><li>Loss of position sense, vibration sense and sensory ataxia </li></ul>
  25. 29. Syringomyelia <ul><li>Neurosyphilis </li></ul><ul><li>Enlargement of central canal of the spinal cord. </li></ul><ul><li>Loss of pain and temperature sensations </li></ul><ul><li>Touch sensation persists. </li></ul><ul><li>Dissociated anesthesia </li></ul>
  26. 30. Subacute combined degeneration of spinal cord <ul><li>Degeneration of lateral and posterior columns </li></ul>