spinal cord-structure, pathways - Anatomický ústav 1. LF...
Transcript of spinal cord-structure, pathways - Anatomický ústav 1. LF...
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Spinal cord
Veronika Němcová
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rostral
dorsal
ventral
caudal
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Basic unit of NS
neuron
synapse
Dendritic spine
2 - oligodendroglie
3 - astrocytes
4 – capillary
5 – myelin sheat
11 – axon collateral
pia mater9- axon
10-dendrit
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ependyme – in
ventricles
microglia -imunity
astrocyte
neuron capillary
oligodendrocyte
makes a myelin
sheath
Axon with myelin
sheath
astrocyte –
pia mater
1) Neurony
2) Glia – supporting cells
astrocyty
oligodendrocyty
microglia
3) Ependyme
microglie
Neuron:glie
1:10?
1:1!
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Types of neurons
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Nissl staining- cresylviolet rough ER
Grey matter of spinal cord
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Dendrites
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Axon
PNS Schwann´s cells
CNS oligodendroglie
Myelin sheath
no ER
collaterals
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Myelinized and nonmyelinized fibers
fast slow
Axon hillock
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Cytoskelet
shape and transport
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Axonal transport
Anterograde – kinesin
Retrograde -dynein
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Axonal transport on microtubules
Slow anterograde 1mm/day – building proteins
Fast anterograde 300mm/day – enzymes and neurotransmitters
Retrograde 200mm/day – chemicals from synaptic cleft, NFG
(Nerve Growth Factor)
mitochondrie
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prof. Petrovický
Retrograde
labelling
Tract tracing studies
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prof. Petrovický
Retrograde labelling
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prof. Petrovický
Double retrograde labelling
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7000 synapses on 1 neuron
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NeurotransmitersBiogennic amines
Adrenaline, noradrenaline, dopamine
Serotonine
Acetylcholine
Histamine
Aminoacids
Glutamate, aspartate– excitatory (e.g. in spinal ganglion)
GABA, glycin – inhibitory (e.g Renshaw´s cells – spinal cord interneurons
Nukleotides
Adenosine
Neuropeptides
Substance P, VIP, somatostatin, cholecystokinin
Gas - NO, CO
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Dopamine
Noradrenaline
Adrenaline
Serotonine
Acetylcholine
Histamine
GABA
Glycine
Adenosinecoffein- block of receptors for adenosine
NEUROTRANSMITTERS
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10
Neural tube and neural crest formation - 3.-4. week
Neural plate
Neural groove
Neural tubeNeural crest Neural cres
neuroporus ant.
neuroporus
post.
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Neural tube and neural crest formation
Neural plate
3. week
Neural groove
Nerval tube
Neural crest
Sensory ganglia
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Brain development
1) prosencephalon
mesencephalon
rhombencephalon
2) telencephalon
diencephalon
mesencephalon
metencephalon
myelencephalon
Primary
SecondaryT
D
Mesen
myelen
meten
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Pontinne flecture
isthmus rhombencephali
flexura cephalica
flexura cervicalis
insula
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Brain development
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Factors influencing the formation of dorsal (bone morphogenetic
proteins, BMPs) and ventral (sonic hedgehog, SHH) parts of
spinal cord
Alar plate
Basal
plate
Sulcus
limitans
Floor plate
Roof plate
motoneurons
Neural
crestchorda dorsalis
(notochord)
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Basal and alar plate
development in spinal cord
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Sagittal section
through th vertebral
canal
C2
L1
foramen magnum
hiatus sacralis
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Borders of vertebral canal
lig. longitudinale posterius
ligg. flava
arcus vertebrae
foramen intervertebrale
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Spinal nerve and vertebral canal
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Meninges of spinal cord
endorhachis
1 spatium epidurale
saccus durae matris
3 spatium
subarachnoideum
lig. denticulatum
arachnoidea
pia mater
2 spatium subdurale
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A B
A- saccus durae matris
sleeves cover roots of
spinal nerves
B- dura mater is cut
transparent arachnoid
covers spinal cord and
nerves roots
C
C posterior root ganglion
(spinal ganglion)
Vessels in pia materNerve roots
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AB
Cervical intumescence
C
1
2
3
4
A- pia mater removed 5-fasciculus cuneatus, 6-fasciculus gracilis
B-pia mater with vessels covers posterior column 7- fila radicularia (rootlets)
C-1-dura mater, 2-anterior root, 3-posterior root, 4-denticulate lig.
5
6
7
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A
BC
A- cauda equina
B-intumestentia lumbosacralis
C-cauda equina
1-dura mater
2-pia mater with vessels
3-filum terminale
4-Conus medullaris
5- roots of sacral and lumbal nerves
1
5
53
3
12
4
4
Lumbosacral
intumescence and
cauda equina
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fila radicularia
C1
C2
C3
Cervical
spinal
cord
dorsal
aspect
ganglion spinale
fasciculus gracilis Golli
fasciculus cuneatus Burdachi
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Thoracic spinal cord
lig. denticulatum (arachnoidea)
saccus durae matris
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Thoracic spinal
cord
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Conus medullaris
+ cauda equina
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Vertebral canal
posterior aspect
Canalis sacralis
conus medullaris
filum durae matris
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Saccus durae matris content bellow L1
Vertebral canal and its arrangement in MRI
L3 level
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Vertebral canal sagittal section
1-discus intervertebralis
2-corpus vertebrae
3-saccus durae matris
4-spatium epidurale
5-spinal cord
6-spatium subdurale
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MRI cervical spinal cord
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MRI vertebral canal
LS region
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Cervical part of vertebral canal
6- spatium epidurale
14- a. vertebralis
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White matter outside - tracts
– columns – funiculi
Anterior
Lateral
Posterior – fasciculus gracilis Goli
- fasciculus cuneatus Burdachi
ant
lat
post
Gray matter inside
Anterior horns – motor
Posterior horns – sensory
Lateral - visceromotoneurons
Fissura mediana anterior
Canalis centralis
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Cervical spinal cord
Ncl. spinalisV
Decussatio
pyramidum
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Thoracic spinal cord FUNICULUS
POSTERIOR
FUNICULUS
ANTERIOR
FUNICULUS
LATERALIS
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Spinal cord
C3
C6
Th6
L3
S3
intumescentia
cervicalis
intumescentia
lumbalis
oooo
C1-8
Th 1-12
L1-5
S1-5
Co1
Filum terminale
Conus
medullaris
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Cervical spinal cord- silver impregnation according
Weigert
11-fasciculus gracilis
12-fascuculus cuneatus
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Thoracic spinal cord - Van Gieson´s staining
15- lateral horn
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Lumbar spinal cord – Weigert´s staining
11-fasciculus gracilis
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Sacral spinal cord
8-cauda equina
11- fasciculus gracilis
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Vertebro-medular topography
vertebral bodies related to spinal cord segments
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Vertebro-medular topography - vertebral bodies related to spinal cord segments
Segment = vertebra
Segment = vertebra +1
all sacral segments = L1 body
Th12-L1 = Th 11 body
L2-L5 = Th12 body
+2
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Dermatoms
parts of skin supplied
from one spinal cord
segmentTh4
Th10
Th12
Th1
V/1
V/2
V/3
Trigeminal
branches
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DermatomesTh 1 on upper limb
!
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Arteries of spinal cord
Yoshioka K et al. Radiographics 2003;23:1215-1225
©2003 by Radiological Society of North America
a.spinalis anterior
Adamkiewicz´s artery
(a.spinalis magna) from a.
intercostalis post. At the level Th9–
L1 (Th7-L2)aa. Intercostales posteriores
a. iliolumbalis
aa. lumbales
aa. sacrales laterales
rr. spinales (radicular arteries)
a. vertebralisa. cervicalis ascendens
a. cervicalis profunda
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Cervical spinal cord supplying
a. spinalis anterior
aa. spinales posteriores
a. vertebralis
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a. intercostalis post
r. spinalis
r. muscularis
Thoracic spinal cord
supplyingAo
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Vertebral canal supplying in sacral region
a. sacrales
laterales
a. iliolumbalis
a. sacralis
mediana
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Spinal cord arteries
vasocoronae
5 longitudinal truncs
r. spinalis
a. spinalis anterior
aa. spinales
posterioresPosterior column
(proprioception)
Anterior horns,
anterior and lateral
columns
(motor)
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Venous plexuses
Plexus venosi
vertebrales externi
anterioresPlexus venosi
vertebrales interni
anteriores
Plexus venosi
vertebrales interni
posteriores
v. lumbalis ascendens
Plexus venosi
vertebrales
externi
posteriores
vv. basivertebrales
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Vertebral venous plexuses• No valves (cancer and infection spreading), anastomoses (
between externi and interni)
• Anastamoses with venous plexuses of pelvis
• Placed: 1) inside canal in epidural space (plexus venosi vertebrales
interni)
• 2) outside the spine (plexus venosi vertebrales externi)
• 3) in bodies of vertebrae (venae basivertebrales)
31 2
2
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Rexed´s laminae (zones)
I – ncl apicalis
II, III – subst. gelatinosa Rolandi
IV,V – ncl proprius
VI – ncl. Stilling-Clark
VII – interneurons
VIII,IX - motoneurons
Propriospinal tracts crosshatched
Visceromotor nucleus
Sensory tracts
Motor tracts
Cerebellar tracts
Dorsal
column
tracts
Ncl intermediolateralis
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Rexed´s zones – Nissl
staining
I – ncl apicalis
II, III – subst. gelatinosa Rolandi
IV,V – ncl proprius
VI – ncl. Stilling-Clark
VII – interneurons
VIII,IX - motoneurons
Bror Rexed
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Comparison of classic and Rexed nomenclature
from to
Spinal nerve
Zones - Nuclei
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Somatotopic arrangement
of motoneurons in ventral
horns
„columns“ of motoneurons for limbs,
(distal muscles more caudally)
C3-C5 ncl. frenicus
S2-S3 Onuf´s nucleus – n.pudendus
C1-5 –ncl spinalis n.XI.
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MOTOR unit
ALFA MOTONEURON
+ ALL MUSCLE FIBER
SUPPLIED BY IT
Number of fibers in unit
m. gastrocnemius (1750) x mm. lumbricales (108)
Number of units in muscle
Např. m. abduktor policis longus 400
(gamma motoneurons – muscle spindle supplying)
Neurotransmitter: ACh
One motor unit
Two motor units
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Dorsal root fibers
A alfa , A beta fibers–
myelinized, fast conducting
proprioception, touch
A delta fibers– poorly myelinized,
C fibers– nonmyelinized, slow
conducting fibers from nociceptors
and thermoreceptors
Neurotransmitters: glutamate +
substance P, VIP, cholecystokinin
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White matter–propriospinal, ascendent, descendent and
cerebellar tracts
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Motor pathways
Cortico-spinal lateral
Rubro-spinal
Cortico-spinal
ventral
Reticulo-spinal
Tecto-spinal
Vestibulo-spinal
Interstitio-spinal C-S voluntary movement ,
NR-S flexors activation
Ret-S muscle tone and a „supraspinal“ movement
Te-S reaction to visual and acoustic stimuli
Ve-S extensors activation
Ist-S TV watching in laying position
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Cortex
Th
RF
Ve
Ru
Gr Cu
Te
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Tractus cortico-spinalis (pyramidal tract)
voluntary movement
Motor part- voluntary movement
Control of sensory tracts
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Lesions of motor neurons
Lesions of motor neurons, results in loss of motor function paralysis
Full paralysis – plegia
Partial paralysis – paresis
Hemiplegia – both ipsilateral extremities are affected
Paraplegia – either both upper or lower extremities are affected
Quadruplegia – all 4 extremities are affected
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Basic signs of motor activity disorders
Lower motor neuron lesions
(poliomyelitis or nerve
lesion)
Muscle tone and stretch and
tendon reflexes are reduced
or absent (flaccid paralysis)
Progressive atrophy of muscles
occurs
EMG detects fibrillation
potentials caused by
isolated contrations of
denervated muscles
In partially denervated muscles,
the inervation is being
renewed
• Upper motor neuron lesions
(bleeding in capsula interna
or transected spinal cord)
• Muscle tone and stretch and
tendon reflexes are
increased (spastic paralysis)
• Superficial reflexes
(abdominal and cremasteric
ones) are extinct
• An abnormal plantar
Babinski reflex occurs
• Voluntary movements are
reduced or absent
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wireless electronic connection between the brain and spinal cord restored
movement in two monkeys that were each paralysed in one leg as a result of a
spinal-cord injury.
Spinal-cord injury: Neural interfaces take another step forward
Andrew Jackson, Nature 539,2016
Bipedal walking?
Problems: 1) maintain balance
2) targeting the movement
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1) tractus interstitiospinalis
2) tractus vestibulospinalis
tractus vestibulospinalisExtensors activation - uncrossed
tractus interstitiospinalisPART OF medial longitudinal fascicle
Coordination of neck and oculomotor
muscles in change of head position
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Fasciculus gracilis
Golli
Fasciculus cuneatus
Burdachi
DK HK
Sensory tracts 1) dorsal column lemniscal tract – proprioception, vibration, touch
2) anterolateral systém pain, touch, activation
Undirect sensory tracts
To cerebellum
S-Crbl d II, S-Crbl v X
S-Ol
Kinetic proprioception from lower limbs
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Anterolateral system
Tracts:
spino-thalamic X
– „fast“ pain,
temperature, touch
spino-reticularis X, II
- „slow“ pain
activation
spino-tectal X
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Spinal cord – center of reflexes
Patelar (knee jerk) reflex L2-L4
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Alfa motoneuron – striated
muscle – extrafusal fibers
Gamma motoneuron –
intrafusal fibers of mucle
spindle
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A alfa
A gamma
Pain, temperature
Vibration, pressure
Anulospiral ending,
flower spray ending
Golgi tendon organ – tension gaited
receptor
Muscle spindle –stretch gated receptor
Muscle spindle compares the length
of intra and extrafusal fibers
It is supplied from gamma
motoneurons
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Gamma loop
mechanism
For muscle tone controle
Gamma motoneurones and muscle tone
Cortex, reticular formation
and red nucleus can
increase (or decrease) the
muscle tone by activation
(inhibition) of gamma
motoneurons (contraction
of intrafusal fibers)
Gamma motoneuron – sensory neuron-alfa motoneuron
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Proprioceptive reflexes
Knee jerk reflex
elongation of muscle -
contraction
Inhibits contraction
Relax
of
antagonistContraction
of
antagonist
Muscle spindle Tendon body
reciprocity
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Proprioceptive reflexes circuits
„supraspinální“ pohyb působení gravitace
tonický napínací
Gravity
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Tonic neck reflexes
„fencing position“
„toward the water“
„toward the prey“
„toward the burrow“
Can be seen after bilateral labyrintectomy
or during development
Neck reflexes
Head dorsiflexion (extensors in action) –
upper limb (HK) extension and lower limb
(DK) flexion
neck
neck
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Tonic neck reflex – fencing posture
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Posterolateral
sclerosis
Syringomyely
Parietal cortex lesion Polyneuritis
Brown-Sequard syndrome
Left posterior inferior
cerbellar art. occlusion
Sensory loss
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Postero-lateral
sclerosis
Syringomyelie Brown-Sequard sy
Loss of
temperature
and pain
senses
Deminished
vibration,
position, 2-
point
discrimination
and joint
sensation
Loss of all
sensationes
Impaired
proprioception
and vibration,
2-point
discrimination
and position
sensation
Impaired
pain and
temperature
sensation
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Syringomyelia
Loss of temperature and pain senses
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Ncl. et tr.
sp.n.V.
Tr. S-Th
Ncl. amb
Lateral medullary syndrome (left
posterior inferior cerebellar artery
occlusion)
Impaired
pain and
temperature
sensation
left face and
right side of
body
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Spinal cord lesion
1) Motor defects– paresis, plegie .
central (spastic), periferal (flaccid), mixed
2) Sensory defects
a) Radicular syndrome(dermatomes) e.g. disc prolaps
hypestesia, anestesia, parestesia, hyperestesia
b) Syringomyelic dissociation – Loss of temperature and pain senses
c) Brown Séquardům syndrom (např. intramedular expansion)
bellow the lesion is ipsilateral deep sensory loss (dorsal column tract) and motor defect (cortico-spinal tract), kontralateral pain and temperature sensory loss)
d) Dorsal column syndrom(e.g. neuranemic syndrom, tabes dorsalis)
loss of proprioception
3) Medullary epiconus syndrome (lesioned segments L4-S2) lower limbs paraparesis. Not affected hip adduction and hip flection, knee extension, loss of sensation bellow the knee and posterior upper tight, automatic bladder, lesioned erection and ejaculation
4) Medullary conus syndrome (lesioned segments S3-S5) loss of sphincters control, automatic bladder, saddle like sensory loss
5) Cauda syndrome(lesion of spinal nerve root bellow L2)
low back pain, sciatica (unilateral or, usually, bilateral), saddle sensory disturbances, bladder and bowel dysfunction, and variable lower extremity motor and sensory loss
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Spinal cord problems1) Developmental malformation (neural tube
closure defects, syringomyelie)
2) tumors (intramedullar, extramedullar)
3) Trauma (comotion, contusion)
4) Vascular disease (ischemie, hemorhagie)
5) Degenerative disease (ALS,)
6) Degenerative vertebral disease
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Neurosurgery can solve
• 1) Anterior spinal artery syndrome (e.g. in vertebral body fracture and compression in vertebral canal) – plegia, loss of pain and temperature sensation, remains only proprioception (vibration)
• 2) Posterior spinal artery syndrome (e.g. in epidural expansion, stab wound) – loss od proprioception and lesiond motor aktivity of distal parts of limbs
• 3) Brown Sequard rare
• 4) Central gray matter syndrome– hyperintensity on MR,
• Affected cortico-spinal tracts, paresis on distal parts of upper limbs
• 5)Compressive spinal cord syndrome – tumor, abscess, tuberculosis
• 6) Syringomyelia.
•
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The sagittal
T2-weighted Turbo
Spin Echo image
demonstrates a
traumatic transection
of the spinal
cord at the level of
C5–C6.
Patient history
4-year-old female patient was
involved
in a high-speed vehicle
accident. At
the scene the girl was
distressed, bradycardic
and not moving limbs. She was
transferred to the Pediatric
Trauma
Centre and MR imaging
requested for
prognostic information
regarding treatment
Images show a
transection of the
cervical cord at the level
of C5–C6 with
approximately 6 mm of
separation.
Transverse
spinal cord
lesion
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24-year-old man involved in high speed motor vehicle accident
MR -marked anterior subluxation of C6 on C7, transection of the spinal cord
(black arrow), edema and hemorrhage in the prevertebral soft tissues (red
arrows) and spinal cord edema extending from C4 to T1 (yellow arrows).
Sagittal T2 STIR
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Sagittal images of the right
facets and left facets. The
bilateral jumped facets are seen
(black arrows).
• Sagittal image shows marked subluxation of C6 on C7 (black arrows) with marked narrowing of the spinal canal.
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MR T1 - Syringomyelia – cavity inside the cervical
spinal cord
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MR T2 syringomyelia
thoracic spinal cord
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Syndrom syringomyelie
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Meningomyelokéle
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Amyotrophic lateral sclerosisPathological Features of ALS from Other Cases
(Luxol Fast Blue–Hematoxylin and Eosin).
• Bunini body in motoneuron of anterior horn, ALS (Panel A, arrow) (photomicrograph courtesy of Dr. David Louis).
• Panel B selective degeneration of cortico-spinal tracts (arrows). Posterior columns are normally myelinizated (arrowheads).
• In anterior root is loss of myelinizated fibers and gliosis (Panel C, right) posterior horn is normal (Panel C, left).
affected central and peripheral neuron
Living - 3-5 years from the diagnosis,
20% die in 1.year – respiratory insuficience
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Rexed´s laminae (zones)
I – ncl apicalis
II, III – subst. gelatinosa Rolandi
IV,V – ncl proprius
VI – ncl. Stilling-Clark
VII – interneurons
VIII,IX - motoneurons
Propriospinal tracts crosshatched
Visceromotor nucleus
Sensory tracts
Motor tracts
Cerebellar tracts
Dorsal
column
tracts
Ncl intermediolateralis
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Sources
• Petrovický, Anatomie III
• Grim, Nanka, Helekal Anatomický Atlas
• Rohen Yokochi, Anatomie člověka, fotografický atlas
• Köpf Maier, Atlas of Human anatomy
• Sobotta, Atlas anatomie člověka
• Batson OV: The function of the vertebral veins and their role in the spread of
metastases. Ann Surg 1940; 112: 138–149.
• Chhabra A et al. Spinal Epidural Space:
Anatomy, Normal variations, and Pathological Lesions
on MR Imaging
• J.M.S. Pearce The Craniospinal Venous System
• M.A. England, J.Wakely, Color atlas of the brain and spinal cord
• Ambler, Poruchy periferních nervů