Spinal cord lesions

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basic physiology of spinal cord lesions.

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SPINAL CORD LESIONS:

SPINAL CORD LESIONS Dr. Shital Ghataliya Dr. Naisargi Bhadukiya

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OUTLINE : TYPES COMPLETE TRANSACTION INCOMLETE TRANSACTION HEMISECTION APPLIED ASPECT

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TYPES : Complete transaction Incomplete transaction Hemisection

Complete transaction:

Complete transaction Causes - Gun shot injury Dislocation of the spine Occlusion of the blood vessel.

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Stages – Stage of spinal shock/stage of flaccidity Stage of reflex activity Stage of failure of reflex activity

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1. stage of spinal shock- Whole body below the level of section is deprived of all activities. Flaccid paralysis. Loss of muscle tone. All the reflexes lost. Urinary bladder and rectum are paralyzed. The penis is flaccid and erection is impossible. If transaction is at the T 1 level cut off all the thoracolumbar sympathetic neurons from the medullary cardiovascular centre producing marked fall in BP. If lesion is at the T 6 all impulses from abdominal viscera are cut off from the brain.

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2. Stage of reflex activity – Autonomic reflex – within days or weeks of cord transaction spinal sympathetic cell bodies appear to recover some tonic discharge. skin sweating, ulcer healing, muscle recovery occurs. Muscle tone returns after 2-3 weeks, causes paraplegia in flexion. Reflex movements – return of reflexes in approx. 2 weeks, like positive Babinski response, mass reflex, deep reflexes, coitus reflex appears.

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3. Stage of failure of reflex activity – May occur due to malnutrition, infection or toxemia. Reflexes are difficult to obtain. Mass reflex disappears. Threshold for all reflexes increases. The muscles waste and become flaccid .

Incomplete transaction:

Incomplete transaction Few tracts escape form injury. Stage of shock – same as complete transaction. Stage of reflex activity – paraplegia in extension Stage of failure of reflex activity – may occur. 2. Stage of reflex activity - All features of UMN lesion. Involuntary movements are frequent. Reflex movements – extensor thrust reflex, crossed extensor reflex, phillipson’s reflex.

Hemisection of spinal cord – brown sequard syndrome:

Hemisection of spinal cord – brown sequard syndrome It is a lesion involving one lateral half of the spinal cord. 1. below the level of lesion – o n the same side – fine touch, tactile localization, tactile discrimination etc. are lost but pain, temperature, crude touch sensation are preserved. UMN type of paralysis which includes increase in muscle tone, loss of superficial reflex and exaggeration of deep reflexes, positive Babinski’s sign, no muscle wasting . Marked fall in BP due to damage to the descending fibres from VMC. on the opposite side – pain, temperature, crude touch sensation are lost, but kinesthetic sensations are preserved. No motor paralysis or few fiber may paralysed.

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2. at the level of lesion – on the same side – complete anaesthesia and lower motor neuron type of paralysis is seen which includes flaccid paralysis, loss of all reflexes, loss of muscle power and tone, muscle wasting. Vasomotor paralysis. o n the opposite side – some loss of pain may occur. Nil or little motor damage may occur. 3. above the level of lesion- on the same side – hyperaesthesia o n the opposite side - hyperaesthesia

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Regional peculiarities – Hemisection at cervical region – pupillary constriction, loss of biceps, triceps, supinator , pronator jerks. If C 3, 4,5 segments involved, paralysis of diaphragm. Hemisection at lumbar region – if L 3,4 involved there will be loss of knee jerk and micturition disturbances. Hemisection at lumbosacral region – loss of control over sphincters of urinary bladder and rectum.

complications:

complications Decubitus ulcer. Hypercalcemia , hypercalciuria , urinary stone. Frequent UTI, septicemia, uremia, come, death.

APPLIED ASPECT:

APPLIED ASPECT Syringomyelia – it occurs due to excessive overgrowth of neuroglial tissue accompanied by cavitation in the grey matter around the central canal of spinal cord. Tabes dorsalis – is a disease caused by syphilis. In this bilateral degeneration of posterior nerve roots. Deafferentation - injury to the dorsal nerve root causes loss of sensory and motor disturbances. Disseminated multiple sclerosis – it is a demyelinating disorder having widespread disseminated involvement of white matter of the central nervous system. Subacute combined degeneration of the spinal cord – in this bilateral degeneration of white fibres of the dorsal column and lateral column of the spinal cord.

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