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   From cervical segments- subtract 1   From upper thoracic segments- subtract 2   From lower thoracic segments- subtra...
   is the phenomena surrounding transection of the    spinal cord that leads to temporary loss or    depression of all or...
 Anterior horn cells-         Myoneural junction-  poliomyelitis                 myasthenia gravis Nerve root- radiculi...
CompressiveExtradural                  IntraduralPott`s disease              Meningioma , lymphoma                        ...
 VascularArteriovenous malformationAntiphospholipid syndrome and other  hypercoagulable states InflammatoryMultiple scle...
   InfectiousViral: HZV, HSV-1 and -2, CMV, HIVBacterial and mycobacterial: Listeria, syphilis,Mycoplasma pneumoniaeParas...
   Trauma   Tumour   Tuberculosis   Thrombosis   Transverse myelitis
COMPRESSIVE            NONCOMPRESSIVE  Bony changes         No bony changes  Root pains           No root pains  Uppe...
 Compressive           Non    compressive Usually gradual         Usually acute  onset                    onset Asymm...
Symptoms                   Intra medullary         Extra medullaryRadicular pain             nil                     commo...
Inflammation of the spinal cord at a single level. Symptoms   develop rapidly and include limb weakness, sensory   disturb...
Investigation MRI shows swelling of spinal cordManagement Methylprednisolone injection followed by oral  prednisoloneGoo...
Anterior spinal artery infarction produces paraplegia  or quadriplegia, sensory loss affecting  pain/temperature but spari...
Paresthesia in hands and feet, early loss of  vibration/position sense, progressive  spastic/ataxic weakness, and areflexi...
Isolated progressive paraparesis runs in some   families. Inheritance is variable. Additional   features including cerebel...
Tubular cavities (syrinxes) form close to the  central canal of the spinal cord. As the syrinx  expands, it compresses ner...
   Skin care issues (Pressure sores)   DVT   Loss of bladder control & UTI   Loss of bowel control   Loss of sensory ...
   Based on etiology   Compressive – decompressive surgery   ATM – steroids   Supportive care   Physiotherapy
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Paraplegia

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Transcript of "Paraplegia"

  1. 1.  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
  2. 2.  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.
  3. 3.  Anterior horn cells-  Myoneural junction- poliomyelitis myasthenia gravis Nerve root- radiculitis  Muscles – myopathy cauda equina  hysterical Peripheral nerves-GB syndrome,peripheralneuropathy
  4. 4. CompressiveExtradural IntraduralPott`s disease Meningioma , lymphoma ,metsMetastatic carcinoma from breast, lung Epidural abscess prostate IntramedullaryMultiple myeloma Spinal cord tumorHerniated disc , fractureCervical spondylosis
  5. 5.  VascularArteriovenous malformationAntiphospholipid syndrome and other hypercoagulable states InflammatoryMultiple sclerosisTransverse myelitisSarcoidosisVasculitis
  6. 6.  InfectiousViral: HZV, HSV-1 and -2, CMV, HIVBacterial and mycobacterial: Listeria, syphilis,Mycoplasma pneumoniaeParasitic: schistosomiasis, toxoplasmosis MetabolicVitamin B12 deficiency (subacute combined degeneration) Syringomyelia
  7. 7.  Trauma Tumour Tuberculosis Thrombosis Transverse myelitis
  8. 8. COMPRESSIVE NONCOMPRESSIVE  Bony changes  No bony changes  Root pains  No root pains  Upper level of  No definite level sensory loss present  Zone of  Absent hyperesthesia may be present
  9. 9.  Compressive  Non compressive Usually gradual  Usually acute onset onset Asymmetrical involvement of  Symmetrical limbs involvement of Bladder bowel limbs disturbance occurs  Occurs but late
  10. 10. Symptoms Intra medullary Extra medullaryRadicular pain nil commonFunicular pain common Less commonVertebral pain unusual commonUMN signs late earlyLMN signs Prominent and diffuse Unusual /segmentalSensory involvement Descending AscendingprogressionSphincter involvement Early LateTrophic changes Common UnusualDissociated sensory loss Yes NoSacral sensation Spared Lost
  11. 11. 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
  12. 12. Investigation MRI shows swelling of spinal cordManagement Methylprednisolone injection followed by oral prednisoloneGood recovery occur in 30% of cases
  13. 13. 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.
  14. 14. 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.
  15. 15. 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.
  16. 16. 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)..
  17. 17.  Skin care issues (Pressure sores) DVT Loss of bladder control & UTI Loss of bowel control Loss of sensory function Loss of motor function Depression
  18. 18.  Based on etiology Compressive – decompressive surgery ATM – steroids Supportive care Physiotherapy
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