This document summarizes motor lesions involving the upper and lower motor neurons. It describes how voluntary acts require the integrity of both upper and lower motor neurons. It then discusses the effects of lesions in different areas, including the cerebral cortex, brainstem, spinal cord, and internal capsule. Key points include how lesions can cause paralysis, spasticity, changes in muscle tone and reflexes on the side opposite or same as the lesion depending on location.
Pyramidal tract by Sunita.M.Tiwale,Prof. Dept of physiology,D.Y.Patil Medical...Physiology Dept
Specific Learning Objectives:
At the end of session the students should be able to :
Enumerate the descending tracts.
Describe the origin, course, termination, collaterals of Pyramidal tract.
Describe the functions of the pyramidal tract.
here i am to explain the Anatomy and physiology of part of the Pyramidal tract, that is the corticospinal tract. I also added the clinical significance of corticospinal tract. The course of the corticospinal tract are well explained.
Clinical aspects of upper and lower motor neuron lesionsReed O'Brien
Lecture by Prof. Osama Shukir Muhammed Amin FRCP(Edin), FRCP(Glasg), FRCP(Ire), FRCP(Lond), FACP, FAHA about the clinical aspects of upper and lower motor neuron lesions.
Pyramidal tract by Sunita.M.Tiwale,Prof. Dept of physiology,D.Y.Patil Medical...Physiology Dept
Specific Learning Objectives:
At the end of session the students should be able to :
Enumerate the descending tracts.
Describe the origin, course, termination, collaterals of Pyramidal tract.
Describe the functions of the pyramidal tract.
here i am to explain the Anatomy and physiology of part of the Pyramidal tract, that is the corticospinal tract. I also added the clinical significance of corticospinal tract. The course of the corticospinal tract are well explained.
Clinical aspects of upper and lower motor neuron lesionsReed O'Brien
Lecture by Prof. Osama Shukir Muhammed Amin FRCP(Edin), FRCP(Glasg), FRCP(Ire), FRCP(Lond), FACP, FAHA about the clinical aspects of upper and lower motor neuron lesions.
Adverse drug reactions (ADRs) are untoward effects of drugs that are given in conventional therapeutic settings. These reactions are extremely common in the practice of medicine and are believed to affect 7% to 8% of patients admitted to a hospital. About 10% of such reactions prove fatal .
This lecture in neuroanatomy was presented and taught by Ahmed Eljack to second level medical students at Alneelain University. It's the second lecture of the spinal cord neuroanatomy (containing the descending tracts and the spinal cord lesions).
This lecture discussed the following topics:
1. Corticospinal tract
2. Other important descending tracts
3. Description of upper and lower motor neurons
4. Characters of upper and lower motor neuron lesions
5. Important spinal cord disorders
Approach to patient with spinal cord lesions & diseases
Localize spinal cord lesions
Determining the Level of the Lesion in Myelopathy
Diseases of spinal cord
enlists and the description of the different descending tracts of the CNS. cortico spinal tract, cortico bulbar tract, extra pyramidal and pyramiddal tracts, homunculus, vestibulospinal tract, reticulo spinal tracts, tectospinal tract, autonomic tract, uppermotor neuron lesion, lower motor neuron lesion, spinal cord injury, brown sequard syndrome. spinal cord infection, degenerative disorders of spinal cord,
Lecture by Prof. Osama Shukir Muhammed Amin FRCP(Edin), FRCP(Glasg), FRCP(Ire), FRCP(Lond), FACP, FAHA, to consolidate information pre-Task Based Learning about Limb Weakness. This lecture addresses lower motor neurons lesions and signs, their localization, and rationale for choosing diagnostic investigations. The next lecture will be about lower motor neuron lesions.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
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1. Motor lesions
Upper and Lower Motor Neurons
The performance of a voluntary act needs the integrity of 2 sets of motor neurons, upper & lower
neurons.
Upper Motor Neurons
These consist of the motor cells of the cerebral cortex & their axons, which relay at the motor nuclei of
the brain stem & spinal cord, chiefly of the opposite side.
These descending tracts include:
●The corticonuclear tract: which arises from area 8 of the frontal cortex & terminates in the motor
nuclei of the III, IV, VI cranial nerves.
●The corticobulbar tract: which arises from the motor area & terminates in the motor nuclei of V, VII,
IX, X, XI & XII.
●The corticospinal tract: (pyramidal tract): which arises from the motor area & terminates at the
anterior horn cells of the spinal cord.
LMN include the following sets:
1.Neurons in the motor nuclei of all the above mentioned cranial nerves & their axons to sk. Muscles
of the eyes & the head
2.Anterior horn cells of spinal cord & their axons to sk. Muscles of the body.
Upper Motor Neuron and Lower Motor Neuron Lesions
Manifestation of UMN lesions (UMNL(
●EXTENT OF PARALYSIS: is wide spread because the pyramidal fibers from a compact bundles which
occupies a small area.
●SITE OF PARALYSIS: is opposite to the lesion e.g. hemorrhage into the right internal capsule causes
hemiplegia or paralysis of the muscles of the left half of the face & the left upper & lower limbs.
●MUSCLE TONE: there is hypertonia & hyperreflexia due to block of the extrapyramidal inhibitory
discharge on the gamma efferents & hence the excitatory reticular formation because unopposed . So,
spasticity is a release phenomenon from the normal inhibitory discharge.
●REFLEXES: superficial reflexes are absent on the affected side as they receive their facilitatory
influence from the pyramidal tracts, while the deep reflexes are exaggerated with appearance of
clonus. Babinski's sign with its center in S1 & S2 is positive.
●WASTING OF THE MUSCLE: is very slight due to exaggerated tone (spasticity). The slight wasting
results from the lack of voluntary movements.
2. ●RESPONSE OF MUSCLE: to electrical stimulation is normal, with normal excitability.
Lower Motor Neuron Lesions
●EXTENT OF PARALYSIS: is localized depending on the site of the lesion.
●SITE OF PARALYSIS: is at the same side of the lesion e.g. damage of the AHCs on the right side of the
spinal cord causes paralysis of the muscle supplied by these AHCs on the right side.
●TONE OF THE MUSCLE: there is hypotonia because the stretch reflex arc is cut.
●REFLEXES: both superficial and deep reflexes are absent in the affected segments.
●WASTING OF THE MUSCLES: is marked due to absence of reflex tone as well as lack of voluntary
movements.
●RESPONSE OF MUSCLES: the response to electrical stimulation is abnormal. The response is weak
contraction with decreased excitability, then no response when it is transformed into fibrous tissue.
Effect of lesions of the pyramidal tracts at various levels
●Lesions of the pyramidal tract cause paralysis of the UMNL type below the level of the lesion.
●However, the side affected and the extent of paralysis vary according to the site of the lesion:
○In area 4: this leads to restricted paralysis in the opposite side e.g. monoplegia ( paralysis of one
limb because area 4 is widespread so it is rarely damaged completely.(
○In corona radiate: this leads to contralateral monoplegia or hemiplegia, depending on the extent
of the lesion.
○In the internal capsule: this often leads to contralateral hemiplegia because almost all fibers are
injured.
○In the brain stem: this leads to contralateral hemiplegia and ipsilateral paralysis of the cranial
nerve of the LMNL type ( due to damage of their nuclei in the brain stem.(
●This condition is called "crossed hemiplegia."
●The nerves affected are as follows:
○If the lesion was in the midbrain, the 3rd
& 4th
are affected.
○If the lesion was in the pons, the 5th
, 6th
, 7th
& 8th
cranial nerves are affected.
○If the lesion was in the medulla, the 9th
, 10th
, 11th
& 12th
cranial nerves are affected.
○Bilateral lesions in the brain stem are rare and lead to quadriplegia and bilateral paralysis of the
cranial nerves.
3. ●In the spinal cord:
A- Bilateral lesions: in the upper cervical region are fatal due to interruption of the respiratory
pathway. In the lower cervical region, they lead to quadriplegia and in the midthoracic region lead to
paraplegia
.
B- Unilateral lesions: in the cervical region they lead to ipsilateral hemiplegia while in the
midthoracic region they lead to ipsilateral monoplegia in the corresponding lower limb. In both
conditions, there is also ipsilateral paralysis of the LMNL type of the muscles at the level of the lesion
due to damage of the spinal motor neurons.
Note:
●PARAPLEGIA: paralysis of the lower limbs.
●MONOPLEGIA: paralysis of one limb.
●HEMIPLEGIA: paralysis of half of the body.
●QUADRIPLEGIA: paralysis of the 4 limbs.
The internal capsule
● The internal capsule is the only subcortical pathway through which nerve fibers ascend to and
descend from the cerebral cortex.
● It is a V shaped consisting of anterior and posterior limbs and a genu (knee).
● It is surrounded by the putamen and globus pallidus laterally and the caudate nucleus and the
thalamus medially.
The anterior limb
It contains descending fibers from the cerebral cortex to the red nucleus, pons to cerebellum,
thalamus, 3rd
, 4th
, & 6th
cranial nerves.
The genu
It contains corticobulbular tract.
The posterior limb
(what is underlined is what we need to memorize. The anatomy is not important) contains:
● THE DESCENDING PYRAMIDAL & EXTRAPYRAMIDAL FIBERS in the anterior 2/3.
4. ● THE SOMATOSENSORY RADIATION that ascends behind the pyramidal fibers from the thalamic nuclei
to the cortical sensory area.
● THE OPTIC RADIATION that ascends behind the somatosensory radiation from the lateral geniculate
body to visual areas in the occipital lobe.
● THE AUDITORY RADIATION that ascends most posteriorly from the medial geniculate body of the
auditory areas in the temporal lobe.
Effect of a unilateral lesion in the posterior limb of the internal capsule:
Such lesion commonly called cerebral stroke is usually caused by thrombosis or hemorrhage of
lenticulo-striate artery (a branch of the middle cerebral artery). Patients pass into an acute then
chronic stage.
Acute stage
This lasts a few days up to 2-3 weeks. It is a stage of acute UMNL , showing the following
manifestations in the opposite side:
● FLACCID PARALYSIS: including the upper & lower limbs, the lower parts of the face & 1/2 of the
tongue.
● HEMIANAESTHESIA: loss of all sensations
● LOSS OF THE SUPERFICIAL REFLEXES.
● MAY BE A POSITIVE BABINISKI'S SIGN.
Notes:
The manifestations of this stage are similar to those of LMNL. However, they can be differentiated
from the LMNL by the following:
a. The extent of paralysis is much more widespread than in LMNL.
b. There is associated hemianaesthesia
c. There may be a +ve Babiniski's sign.
d. Slight absence of muscle atrophy.
Chronic (permanent or spastic) stage
The main manifestations of this stage include the following:
► Contralateral hemiplegia: of the UMNL type, which is characterized by hypertonia, muscle spasticiy
of clasp knife type, exaggerated tendon jerks & clonus, loss of superficial reflexes & apparent +ve
Babiniski's sign.
5. Notes
● Partial recovery occurs after a variable period by the effect of the ipsilateral corticospinal tract, the
extrapyramidal tracts as the corticorubral spinal pathway, so, the patient can stand & even walk, but
the fine skilled movements of the fingers & hands are permanently lost.
● Permanent loss of fine sensations in the opposite side, but the crude sensations recover gradually.
● CONTRALATERAL HOMONYMOUS HEMIANOPIA: Loss of vision in the opposite half of the 2 visual fields
due to interruption of signals from the temporal part of ipsilateral retina of nasal part of contralateral
retina.
● DIMINISHED HEARING POWER: In both ears (by about 50% ), because of damage of auditory radiation.
Complete SC transaction
● This result usually from accidents.
● Immediate & ever-lasting loss of sensation of voluntary movements occur due to cut of all sensory
motor tracts below the transaction.
● Transaction in the upper cervical regions (above the 3rd
cervical segment ) result in immediate death
due to respiratory arrest as in hinging.
● However, at lower levels, patients pass 3 stages: spinal shock, recovery of spinal reflex activity, then
its failure & death.
The following stage follow cord transaction:
■ STAGE OF SPINAL SHOCK ( weeks to months in men): all cord function are depressed.
● The manifestation of this stage are the following:
- Paralysis of all muscle below the lesion (quadriplegia or paraplegia ) due to cut of UMN.
- Complete loss of all sensation below the level of transaction.
- Loss of cord reflexes, as the stretch reflex, hence the paralysed muscle are flaccid & the deep
reflexes are absent. The other reflexes are also absent such as the withdrawal flexor reflex.
- ABP (arterial blood pressure ) drops markedly if the transaction is at the level of the 1st
thoracic segment, but slight drop occurs if the lesion is below the 2ed
lumber segment. This
drop of ABP as well as the vascular VD are due to sympathetic activity block. However, the
pressure return to normal within few days.
- Loss of control micturition & defecation reflexes because facilitatory pathway from the
higher centers, responsible for bladder & rectum evacuation are interrupted by the
transaction leading to retention with over flow with dribbling of urine by a full bladder. This
returns back after the 1st
few weeks.
6. - Loss of erection.
● Cause of spinal shock:
○ It is due to sudden withdrawal of supraspinal facilitation on spinal alpha motor neurons,
namely: the continual tonic discharge transmitted along the excitatory reticalocpinal,
vestibulospinal & corticospinal tracts.
● Duration of spinal shock:
○ The Duration of spinal shock differs in different animals according to the degree of
development of cerebral cortex.
○ It is only a few minutes in rats.
○ In human, the duration last 2-6 weeks.
● Complication of spinal shock:
○ hypotrension specially in high-level spinal cord lesion.
○ Increase protein catabolism due to lack of movement causing muscle wasting & bone
dissolution.
○ Ischemia of the compresed against bed ( upper back, gluteal region and heels ) which heal
poorly due to protein depletion.
○ Urinary tract infection due to urine stasis.
○ Fall of body temp. due to reduction of the metabolic rate after loss of muscle tone.
Management of the Spinal Cord Lesions
● This is aimed at rapid recovery of the spinal reflex activity which can be achieved by the
following:
○ A huge dose of Glucocorticoids (10g/day) though their anti-inflammatory action could
reduce the death rate from 80% to 8%.
○ Antibiotics & good nursing care prevents infections & reduces the mortality too.
○ Stimulants to the spinal centers as Amphetamines & Neurotrophins.
○ Bladder catheterization to prevent urine retention & rectal enema (to evacuate the rectum).
○ Prevention of bed sore by cleaning skin with an antiseptic & frequent changing of the
patient's position in bed.
○ Adequate nutrition (malnutrition delays recovery).
7. Stages of Recovery of the Spinal Reflex Activity
● After the stage of spinal shock, the spinal centers below the level of the lesion recover gradually (but
the sensations & voluntary movements never recover because the tracts in the spinal cord cannot
regenerate due to lack of neurolema.
● Spinal recovery occurs as the following:
• The static stretch (muscle tone) recovers spastic paralysis
• It appears first in the flexor muscles (causing paraplegia in flexion).
• Then a few months later, the extension muscle tone predominates resulting in
paraplegia in extension.
• This is followed by other extensor responses e.g. positive supporting reaction so the
patient can stand without support.
• As a result of recovery of muscle tone the metabolic rate increases, the body temperature
rises towards normal level.
• The activity of the spinal vasomotor centers (lateral horn cells) is restored, leading to
vasoconstriction so the ABP rises (but it remains labile because its precise control
mechanism by the baroreceptors is absent).
• Reflex micturation and defecation return but are autonomic (as in infants) due to
absence to voluntary control.
• Sexual reflexes recover (stimulation of the external genitalia in males leading to
erection).
• Appearances of the mass reflex.
Mass Reflex
● This is a hyperactive spinal reflex response that appears after a few months.
● Mild noxious stimuli applied to the skin below the level of the lesion results in a wide range spread
effects due to irradiation of signals in spinal cord to involve multiple somatic & autonomic centers.
● Such effects includes:
1. Exaggerated withdrawal of the stimulated part
2. Urination & defecation
3. Skin pallor & profuse sweating
4. Fluctuation of the ABP (usually rise)
Notes
8. ● Patient can be trained to induce urination or defecation through producing intentional mass reflex
(by striking or pinching the thigh skin).
● The flexor withdrawal reflex & Babiniski signs are usually the 1st
to appear followed by extensor
reflex e.g. knee jerk.
Possible mechanisms of The Reappearance of Spinal Reflexes
● Development of denervation hypersensitivity, the Spinal neuron becomes hypersensitive to
mediators released by remaining excitatory endings.
● Growth of new collaterals from preexisting neurons & formation of additional excitatory endings on
interneuron and motor neurons (spinal neurons).
● Replace of spinal centers from the normal inhibitory control of the highest centers.
Stage of Failure of Reflex Activity
●This is a terminal (premortal)stage that results from bad management during the recovery stage.
●Urinary tract infection and bed sores infection result in failure of reflex activity and the patient dies
from renal failure
●The spinal centers below the level of the lesion are depressed once more leading to:
○Loss of the muscle tone and tendon jerks then mass reflex,withdrawl reflex and
babiniski's sign
○Loss of the defecation and micturtion reflexes resulting in constipation and urine
retention with over flow
○Hypotension due to depression of spinal VC center .THE 3RD
stage doesn't now days occur
because of perfect nursing and administration of antibiotics, both lines of treatment .guard against
bed source and renal infection