Spinal cord syndromes

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Spinal cord syndromes

  1. 1. Spinal cord syndromes
  2. 2. CLASSIFICATION A. COMPLETE B. INCOMPLETE
  3. 3. COMPLETE CORD SYNDROMES a) TRAUMA b) METASTATIC CARCINOMA c) MULTIPLE SCLEROSIS d) SPINAL EPIDURAL HAEMATOMA e) AUTOIMMUNE DISORDERS f) POSTVACCINIAL SYNDROME
  4. 4. INCOMPLETE CORD SYNDROMES a. BROWN SEQUARD SYNDROME b. CENTRAL CORD SYNDROME c. ANTERIOR CORD SYNDROME d. POSTERIOR CORD SYNDROME e. CONUS MEDULLARIS SYNDROME f. CAUDA EQUINA SYNDROME
  5. 5. BROWN SEQUARD SYNDROME  Hemi section of the spinal cord
  6. 6. CAUSES  Extramedullary lesions  Penetrating trauma  Penetrating tumour
  7. 7. Clinical features Sensory  Ipsilateral loss of proprioception due to posterior column invovement  Contrlateral loss of pain and temperature due to involvement of lateral spinothalamic tract.
  8. 8. Motor  ipsilateral spastic weakness due to descending corticospinal tract involvement  LMN signs at the level of lesion
  9. 9. CENTRAL CORD SYNDROME  Results from damage to the gray matter nerve cells and crossing spinothalamic tracts near the central canal.
  10. 10. CAUSES  Syringomyelia  Hyperextension injuries of neck  Intrmedullary tumours  Trauma  Arnold chiari syndrome type 1 and type 2  Dandy walker malformation
  11. 11. CLINICAL FEATURES Sensory  Dissociated sensory loss  Loss of pain and temperature sense over shoulders, lower neck and upper trunk in contrast to preservation of light touch, joint position and vibration sense
  12. 12. Motor  Arm weakness out of proportion to leg weakness
  13. 13. ANTERIOR CORD SYNDROME  Area supplied by anterior spinal artery is affected
  14. 14. Extensive bilateral tissue destruction with sparing of posterior column Causes  Hyperflexion injuries  Acute disc herniation or ischemia from anterior spinal artery occlusion
  15. 15. CLINICAL FEATURES  Motor sensory and autonomic functions are lost below the level of lesion  Vibration and position sense are retained.
  16. 16. MANAGEMENT  With both complete and incomplete paralysis, overall management of the patient is important.  Patient transported with great care to prevent further damage  Skin: every 2 hrs patient is gently rolled to side and back is washed, dried and powdered to prevent pressure sores  Bladder and bowel: bladder catheterised, bag is changed twice weekly to prevent urethral and bladder complications , catheter blockage and infection. bladder training as early as possible. If there is high residual urine after bladder emptying, cystography and cystometry is done.After 3 mths of bladder training, transurethral resection of the bladder neck or sphincterotomy may be done
  17. 17.  Muscles and joints: passive movement of joints through their full range twice daily to prevent flexion contractures. Callipers used to keep knees straight and feet plantigrade. If flexion contracture develops, tenotomies are necessary. Painful flexion spasms are relieved by tenotomies, neurectomies, rhizotomies or intrathecal injection of alcohol. Heterotopic ossification if interferes with function are excised once it is mature.
  18. 18.  Tendon transfers: Some function of the UL can be regained. If only deltoid and biceps are working(c5,c6) , a posterior deltoid to triceps transfer using interposition tendon will replace elbow extension(c7 fn) If brachioradialis(c6) is working, it can be transferred to become a wrist extensor.on active extension of the wrist, the basal joint of the thumb is passively flexed. If extensor carpi radialis longus and brevis( c7) are both available, one can be transferred into the flexor pollicis longus to provide active thumb flexion(c8). Constant enthusiasm and encouragement by doctors, physiotherapists and nurses is essential.
  19. 19. THANK YOU

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