Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.
<ul><li>Paraparesis </li></ul><ul><li>By Dr. Osman Sadig Bukhari </li></ul>
<ul><li>Definitions: </li></ul><ul><li>1- Paraparesis </li></ul><ul><li>2- Paraplegia </li></ul><ul><li>3- Quadriparesis o...
<ul><li>Causes: </li></ul><ul><li>1- Spinal lesions : </li></ul><ul><li>A- Spinal cord compression++++ </li></ul><ul><li>B...
<ul><li>- Familial  - Vascular dis of cord </li></ul><ul><li>- Tropical spastic paraparesis </li></ul><ul><li>- Non metast...
<ul><li>2- Cerebral lesions : </li></ul><ul><li>- Cerebral palsy  - Para sagittal cortical lesions </li></ul><ul><li>- men...
<ul><li>Spinal cord compression </li></ul><ul><li>Principal features of cord compression  are: </li></ul><ul><li>1-  Radic...
<ul><li>Cord compression is a medical emergency   and early stages of neuronal damage is  reversible, hence the importance...
<ul><li>Causes of spinal cord compression </li></ul><ul><li>1-  Extradural ( 80% of causes  ) </li></ul><ul><li>- trauma  ...
<ul><li>2- Intradural extra medullary  (15 %) </li></ul><ul><li>- meningiomas </li></ul><ul><li>- neurofibroma </li></ul><...
<ul><li>3- Intradural intramedullary  (5%) </li></ul><ul><li>- glioma </li></ul><ul><li>- ependymoma </li></ul><ul><li>- h...
<ul><li>6- Rare causes : </li></ul><ul><li>- Pagets  - Scoliosis & vertebral anomalies </li></ul><ul><li>- Parasitic cysts...
<ul><li>Clinical presentation of cord compress </li></ul><ul><li>This depends on the: </li></ul><ul><li>1-  anatomical lev...
<ul><li>Symptoms : </li></ul><ul><li>- Spinal pain & root pain  aggravated by cough, </li></ul><ul><li>sneezing or straini...
<ul><li>Signs : </li></ul><ul><li>Depends on the level of compression </li></ul><ul><li>1-  Above C5 : UMN signs & sensory...
<ul><li>5-  Quda equina : LMN signs in the LL,  dermatomal sensory loss & sphincteric  disturbances </li></ul><ul><li>6-  ...
<ul><li>Investigations: </li></ul><ul><li>Patients with short history & progressive course </li></ul><ul><li>should be urg...
<ul><li>Management: </li></ul><ul><li>1-  management of cord compression : </li></ul><ul><li>- Depends on the nature of th...
<ul><li>2- Management of paraplegia : </li></ul><ul><li>- Improve general health & morale.  - Recognize & TR infections ea...
<ul><li>- Care of the skin: avoid pressure sores by </li></ul><ul><li>using ripple mattresses & avoid pressure </li></ul><...
Upcoming SlideShare
Loading in …5
×

Paraparesis

8,048 views

Published on

Published in: Health & Medicine
  • New E-book Reveals Unique Holistic Strategies to Cure Acne. Discover How To Quickly And Easily Cure Acne Permanently...Even If Everything Else You Tried had Failed... Without Drugs, Without Over The Counters, and Without Nasty Side Effects - Guaranteed! ➤➤ http://t.cn/AiWGkfAm
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • How I Cured My Candida, Life-long Sufferer Discovers, Powerful Secret To Yeast Infection Freedom ♣♣♣ https://tinyurl.com/y4uu6uch
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • It's been ten months without a yeast infection. More than that, for the past couple of months I only had one migraine attack, comparing to six a week as I used to. I also very often suffered from runny nose and acne on my forehead. Since I started your program, it's been like a miracle. My acne disappeared in less than 2 weeks, I lost 10 pounds, and the flu like symptoms I often use to suffer from are also a thing of the past. I feel so young and empowered and I would have never believed there was a natural solution for my problems, if I was told a year ago. I wish everybody knew about this method. There are so many hopeless women and men out there with candida yeast infections. I know I will never have to go through that again. ♥♥♥ http://ishbv.com/index7/pdf
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here

Paraparesis

  1. 1. <ul><li>Paraparesis </li></ul><ul><li>By Dr. Osman Sadig Bukhari </li></ul>
  2. 2. <ul><li>Definitions: </li></ul><ul><li>1- Paraparesis </li></ul><ul><li>2- Paraplegia </li></ul><ul><li>3- Quadriparesis or Tetraparesis </li></ul><ul><li>4- Quadriplegia or Tetraplegia </li></ul><ul><li>** These are sequelae of bilateral damage to </li></ul><ul><li>the corticospinal tracts. </li></ul>
  3. 3. <ul><li>Causes: </li></ul><ul><li>1- Spinal lesions : </li></ul><ul><li>A- Spinal cord compression++++ </li></ul><ul><li>B- Spinal cord diseases: </li></ul><ul><li>- Multiple sclerosis - Myelitis </li></ul><ul><li>- Motor Neurone disease </li></ul><ul><li>- SACD of the cord </li></ul><ul><li>- anterior spinal artery occlusion </li></ul><ul><li>- Syringomyelia - Syphilis </li></ul>
  4. 4. <ul><li>- Familial - Vascular dis of cord </li></ul><ul><li>- Tropical spastic paraparesis </li></ul><ul><li>- Non metastatic manifestation of malig. </li></ul><ul><li>- HIV associated myelopathy. - Radiation myelopathy </li></ul><ul><li>- Fredereick's ataxia - Lathyrism </li></ul>
  5. 5. <ul><li>2- Cerebral lesions : </li></ul><ul><li>- Cerebral palsy - Para sagittal cortical lesions </li></ul><ul><li>- meningiomas </li></ul><ul><li>- venous sinus thrombosis </li></ul><ul><li>- Hydrocephalus </li></ul><ul><li>- Multiple cerebral infarcts </li></ul><ul><li>3- Peripheral Nerves e.g. GB </li></ul><ul><li>4- Muscle diseases </li></ul><ul><li>5- Hysteria </li></ul>
  6. 6. <ul><li>Spinal cord compression </li></ul><ul><li>Principal features of cord compression are: </li></ul><ul><li>1- Radicular pain at the level of compression sp. worse on coughing & straining. </li></ul><ul><li>2- Spastic paraparesis or quadriparesis. The </li></ul><ul><li>course depends on the underlying pathology </li></ul><ul><li>3- Sensory loss below the compression- sensory level </li></ul><ul><li>4- Retention of urine & constipation. </li></ul>
  7. 7. <ul><li>Cord compression is a medical emergency and early stages of neuronal damage is reversible, hence the importance of early diagnosis and TR. Cord damage is due to : </li></ul><ul><li>1- Direct ly by pressure </li></ul><ul><li>2- Indirect ly by edema from venous obstruct </li></ul><ul><li>and ischemia from arterial obstruction </li></ul><ul><li>leading to impaired neuronal fn & cord </li></ul><ul><li>necrosis. </li></ul>
  8. 8. <ul><li>Causes of spinal cord compression </li></ul><ul><li>1- Extradural ( 80% of causes ) </li></ul><ul><li>- trauma - chronic degenerative & disc prolapse </li></ul><ul><li>- Tb - metastatic tumours </li></ul><ul><li>- myeloma - granulomas - extradural abscess </li></ul>
  9. 9. <ul><li>2- Intradural extra medullary (15 %) </li></ul><ul><li>- meningiomas </li></ul><ul><li>- neurofibroma </li></ul><ul><li>- ependymoma </li></ul><ul><li>- metastasis </li></ul><ul><li>- epidural abscess & haemorrhage </li></ul><ul><li>- lymphomas & leukaemias </li></ul>
  10. 10. <ul><li>3- Intradural intramedullary (5%) </li></ul><ul><li>- glioma </li></ul><ul><li>- ependymoma </li></ul><ul><li>- haemangioblastoma </li></ul><ul><li>- lipoma </li></ul><ul><li>- teratoma </li></ul><ul><li>Extra medullary tumours (extra & intra dural) </li></ul><ul><li>cause gradual cord compression over Ws and </li></ul><ul><li>Ms with root pain & sensory level. </li></ul><ul><li>Intra medullary tumours have slow progressive </li></ul><ul><li>course with early sphincter disturbance and suspended anaethesia. </li></ul>
  11. 11. <ul><li>6- Rare causes : </li></ul><ul><li>- Pagets - Scoliosis & vertebral anomalies </li></ul><ul><li>- Parasitic cysts </li></ul><ul><li>- aneurysmal bone cyst </li></ul><ul><li>- vertebral angioma - haematomyelia </li></ul><ul><li>- arachnoiditis - osteoporosis with fracture </li></ul><ul><li>- A/V malformation. </li></ul>
  12. 12. <ul><li>Clinical presentation of cord compress </li></ul><ul><li>This depends on the: </li></ul><ul><li>1- anatomical level of compression </li></ul><ul><li>2- nature of path. </li></ul><ul><li>Onset : </li></ul><ul><li>Symptoms develop over Ms, days or hours </li></ul><ul><li>depending on the cause. It may be acute in traumatic & metastatic compression. </li></ul>
  13. 13. <ul><li>Symptoms : </li></ul><ul><li>- Spinal pain & root pain aggravated by cough, </li></ul><ul><li>sneezing or straining. </li></ul><ul><li>- Paraesthesia, numbness or cold sensation </li></ul><ul><li>starting distally & ascending proximally to the </li></ul><ul><li>level of compression. </li></ul><ul><li>- Weakness, heaviness or stiffness of the limbs </li></ul><ul><li>- Urgency or hesitancy of micturition & eventual </li></ul><ul><li>retention of urine. Constipation . </li></ul>
  14. 14. <ul><li>Signs : </li></ul><ul><li>Depends on the level of compression </li></ul><ul><li>1- Above C5 : UMN signs & sensory loss in </li></ul><ul><li>all limbs </li></ul><ul><li>2- C5—T1 : LMN signs & segmental sensory loss </li></ul><ul><li>in the upper limbs & UMN signs and </li></ul><ul><li>sensory loss in the lower limbs. </li></ul><ul><li>3- Thoracic cord : Spastic paraparesis & sensory </li></ul><ul><li>loss below the level of compression </li></ul><ul><li>with sphincteric disturbances. </li></ul><ul><li>4- Conus medullaries : LMN signs in the LL, </li></ul><ul><li>extens planter response, loss of sensation in the sacral area & sphin disturbance </li></ul>
  15. 15. <ul><li>5- Quda equina : LMN signs in the LL, dermatomal sensory loss & sphincteric disturbances </li></ul><ul><li>6- Brown Sequard (cord hemi section): band of </li></ul><ul><li>hyperaesthesia at the level at the level of the lesion, ipsilateral loss of proprioception & UMN signs with contra lateral loss of spinothalamic sensations. </li></ul>
  16. 16. <ul><li>Investigations: </li></ul><ul><li>Patients with short history & progressive course </li></ul><ul><li>should be urgently investigated. </li></ul><ul><li>1- Plain X ray spine </li></ul><ul><li>2- CT scan </li></ul><ul><li>3- MRI : single most imp investigation. It localize </li></ul><ul><li>the site, extent & nature of za lesion. </li></ul><ul><li>4- CXR </li></ul><ul><li>5- CSF + (myelography- rarely used now). </li></ul><ul><li>Features of compression & spinal block are </li></ul><ul><li>xanthochromia, protein/ cell dissociation and </li></ul><ul><li>+ve Quickensteds test. </li></ul>
  17. 17. <ul><li>Management: </li></ul><ul><li>1- management of cord compression : </li></ul><ul><li>- Depends on the nature of the underlying lesion </li></ul><ul><li>- Early recognition of cord compression & early decompression is vital. </li></ul><ul><li>- Early surgical exploration is frequently </li></ul><ul><li>necessary & the result of early removal of benign tumours are encouraging. </li></ul>
  18. 18. <ul><li>2- Management of paraplegia : </li></ul><ul><li>- Improve general health & morale. - Recognize & TR infections early e.g. UTI. </li></ul><ul><li>CRF is the commonest cause of death in </li></ul><ul><li>paraplegics. </li></ul><ul><li>- Skilled nursing care: </li></ul><ul><li>- Bladder : catheterization to avoid stasis, </li></ul><ul><li>UTI & bladder calculi. </li></ul><ul><li>- Bowel: avoid constipation & faecal impact </li></ul><ul><li>by enema & manual removal till reflex </li></ul><ul><li>rectal emptying develop later. </li></ul>
  19. 19. <ul><li>- Care of the skin: avoid pressure sores by </li></ul><ul><li>using ripple mattresses & avoid pressure </li></ul><ul><li>palsies. - Physiotherapy, prevent contractures, baclofen and diazepam for spasticity. </li></ul><ul><li>- Rehabilitation: psychotherapy, walking aids, </li></ul><ul><li>occupational therapy & social support. </li></ul>

×