Syndromes Of Spinal Cord

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  • SYNDROMES OF SPINAL CORD DR.A.MEENAKSHI PROF.S.TITOS UNIT M6
    • It is divided into complete and incomplete cord syndromes.
    • INCOMPLETE CORD SYNDROMES.
    • Brown sequards syndrome.
    • Central cord syndrome.
    • Anterior cord syndrome.
    • Posterior cord syndrome.
    • Conus medullaris syndrome.
    • Cauda equina syndrome.
  • COMPLETE CORD TRANSECTION
  • Complete transaction of spinal cord
    • causes-
    • Trauma
    • Metastatic carcinoma
    • Multiple sclerosis
    • Spinal epidural haematoma
    • Autoimmune disorders
    • Post vaccinial syndromes.
    • All ascending tracts from below and descending tracts from above are interrupted.
    • Affects motor sensory and autonomic functions.
    • SENSORY
    • all sensations are affected.
    • Pin prick test is very valuable.
    • Sensory level is usually 2 segments below the level of lesion.
    • Segmental paresthesia occur at the level of lesion.
    • Motor -paraplegia due to corticospinal tract.
    • First spinal shock-followed by hypertonic hyperreflexicparaplegia.
    • Loss of abdominal and cremastric reflexes.
    • At the level of lesion LMN signs occur.
    • Autonomic -
    • Urinary retention and constipation.
    • Anhidrosis ,trophic skin changes, vasomotor instability below the level of lesion.
    • Sexual dysfunction can occur.
  • BROWN SEQUARDS SYNDROME
  • BROWN SEQUARDS SYNDROME
    • Due to damage to one lateral half of spinal cord.
    • SENSORY
    • Ipsilateral loss of proprioception due to post column involvement.
    • Contralateral loss of pain and temperature due to .involvement of lateral spinothalamic tract.
    • MOTOR -Ipsilateral spastic weakness due to descending corticospinal tract involvement
    • LMNsigns at the level of lesion.
    • Caused by extramedullary lesions
    • Usually caused by penetrating trauma or tumour.
  • CENTRAL CORD SYNDROME
  • CENTRAL CORD SYNDROME
  • CENTRAL CORD SYNDROME
    • Most common cause is syringomyelia.others hyperextension injuries of neck,intramedullary tumours,trauma.
    • Associated with chiari type 1 and 2.and dandy walker malformation.
    • SENSORY
    • Pain and temperature are affected.
    • Touch and proprioception are preserved.
    • Dissociative anaesthesia.
    • Shawl like distribution of sensory loss.
    • MOTOR .
    • Upper limb weakness >lowerlimb
        • Other features;
      • Horners syndrome
      • Kyphoscoliosis
      • . Sacral sparing
      • Neuropathic arthropathy of shoulder and elbow joint
      • Prognosis is fair.
    • Occurs due to neurosyphilis,diabetes mellitus
    • Usually occurs 10 to 20 yrs after infection
    • SENSORY
    • Impaired position and vibration sense in LL
    • Tactile and postural hallucinations can occur.
    • Numbness or paresthesia are frequent complaints..
    • Sensory ataxia.
    • Positive rhomberg sign.
    • Positive sink sign
    • Positive lhermittes sign.
    POSTERIOR COLUMN SYNDROME
    • Abadies sign positive.
    • Urinary incontinence.
    • Absent knee and ankle jerk.(areflexia,hypotonia)
    • Abdominal and laryngeal crisis can occur.
    • Charcots joint.
    • miotic and irregular pupil not reacting to light.
    • Argyl robertson pupil
  • POSTERO LATERAL COLUMN DISEASE
      • CAUSES;
    • VITB12 DEFICIENCY
    • AIDS
    • HTLV ASSOCIATED MYELOPATHY.
    • CERVICAL SPONDYLOSIS
    • Paresthesia in feet
    • Loss of proprioception and vibration in legs
    • Sensory ataxia
    • positive rhomberg sign
    • Bladder atony
    • Corticospinal tract involvement;spasticity,hyperreflexia ,bilateral Babinski sign.
    • Aids:associated dementia and spastic bladder is present
    • HTLV associated myelopathy;slowly progressive paraparesis increase in csf igG with antibodies to HTLV1.
  • ANTERIOR HORN CELL SYNDROMES
    • CAUSED BY SPINAL MUSCULAR ATROPHY.
    • MOTOR
    • weakness ,atrophy and fasciculations.
    • Hypotonia,depressed reflexes.
    • Muscles of trunk and extremities are affected.
    • Sensory system is not affected.
  • Ant horn cell and pyramidal tract syndrome
    • Occurs in amytrophic lateral sclerosis.
    • Affects the ant horn cells and corticospinal tract.
    • Both lmn and umn sign occur.
    • MOTOR
    • Ant horn cell-paresis ,atrophy,and fasciculations.
    • Corticospinal tract paresis ,spasticity and extensor plantar response.
    • its usually unilateral with muscle weakness
    • Reflexes are often exaggerated.
    • Bulbar and pseudo bulbar involvement occurs.
    • Sensory system is not affected.
    • Superficial reflex-abdominal reflex is preserved
  • SPINAL ARTERY
  • ANTERIOR SPINAL ARTERY SYNDROME.
  • VASCULAR SYNDROMES OF SPINAL CORD
    • Mostly occurs due to anterior spinal artery.
    • conus medullaris is frequently involved.lies opposite to vertebral bodies T12 and L1.
    • Neck pain of sudden onset.
    • MOTOR
    • Flaccid and areflexic paraplegia
    • SENSORY
    • Loss of pain and temperature.
    • Preservation of positon and vibration.
    • AUTONOMIC
    • urinary incontinence.
    • Spinal cord infarction usually occurs in T1 to T4 segment.and L1
    • Occurs due to syphilitic arteritis ,aortic dissection,atherosclerosis of aorta,SLE ,AIDS,AV malformation
    • POST SPINAL ARTERY SYNDROME
    • UNCOMMON
    • Loss of proprioception and vibratory sense.
    • Pain and temperature is preserved.
    • Absence of motor deficit.
  • CONUS MEDULLARIS SYNDROME
    • Contributes to 25%spinal cord injuries.
    • Lies opposite to vertebral bodies of T12 and L1.
    • Caused by flexion distraction injuries and burst fractures.
    • Both UMN and LMN deficits occur.
    • Development of neurogenic bladder.
  • CAUDA EQUINA SYNDROME
  • CAUDA EQUINA SYNDROME. Begins at L2 disk space distal to conus medullaris. MOTOR Flaccid lower extremities. Knee and ankle jerk absent. SENSORY -Asymmetrical sensory loss Saddle anaesthesia Loss of sensation around perineum,anus,genitals. AUTONOMIC -Loss of bladder and bowel function. Urinary retention. Occurs due to acute disk herniation epidural haematoma,tumour
  • ANTERIOR CORD SYNDROME
  • ANTERIOR CORD SYNDROME
  • ANTERIOR CORD SYNDROME
    • Usually caused by hyperflexion injuries.
    • Paralysis below the level of lesion.
    • Pain and temperature loss.
    • Dorsal column is preserved.
    • Prognosis is poor.
    • Area supplied by anterior spinal artery is affected.
    • THANK YOU