Spinal Cord Disorder for final MBBS-Prof. Nimal Senanayake

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Information about Spinal Cord Disorder for final MBBS-Prof. Nimal Senanayake
Health & Medicine

Published on December 1, 2013

Author: samankaru

Source: slideshare.net

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Spinal Cord Disorder for final MBBS-Prof. Nimal Senanayake

SPINAL CORD DISORDER Prof. Nimal Senanayake Faculty of medicine University of Peradeniya Sri Lanka

SPINAL CORD DISORDERS Noncompressive Compressive

NONCOMPRESSIVE SPINAL CORD DISORDERS Heredo-degenerative Inflammatory Infective Vascular Nutritional Toxic-nutritional

HEREDO-DEGENERATIVE Motor neuron disease (PMA, ALS) Spinal muscular atrophy (SMA) Hereditary spastic paraparesis Spino-cerebellar degeneration Fredreich’s ataxia Syringomyelia (-bulbia)

HEREDO-DEGENERATIVE Motor neuron disease A. Progressive muscular atrophy B. Amyotrophic lateral sclerosis C. Progressive bulbar palsy D. Pseudo-bulbar palsy All types involve Ant horn cell Gradual weakness & wasting of muscles

HEREDO-DEGENERATIVE Motor neuron disease A. Progressive muscular atrophy B. Amyotrophic lateral sclerosis C. Progressive bulbar palsy D. Pseudo-bulbar palsy Commonest type Ant horn cell + corticospinal tract→ Combination of both UMN & LMN features

HEREDO-DEGENERATIVE Motor neuron disease A. Progressive muscular atrophy B. Amyotrophic lateral sclerosis C. Progressive bulbar palsy D. Pseudo-bulbar palsy and Bulbar (medulla oblongata) features

HEREDO-DEGENERATIVE Motor neuron disease A. Progressive muscular atrophy B. Amyotrophic lateral sclerosis C. Progressive bulbar palsy D. Pseudo-bulbar palsy and Pseudobulbar features

Motor Neuron Disease (Amyotrophic Lateral Sclerosis [ALS]) • • • • • • • • Spastic weakness of UL, LL Wasting of muscles (esp. hand muscles) Widespread fasciculation Tendon reflexes exaggerated Plantar extensor/flexor No sensory symptoms/signs Wasting, fasciculation of tongue Dysarthria, Dysphagia (Progressive bulbar palsy)

HEREDO-DEGENERATIVE Spinal muscular atrophy (SMA) A. Infantile (Werdnig-Hoffmann) B. Childhood (Kugelberg-Welander) C. Adult forms

HEREDO-DEGENERATIVE Hereditary spastic paraparesis

HEREDO-DEGENERATIVE Spino-cerebellar degeneration

HEREDO-DEGENERATIVE Fredreich’s ataxia

HEREDO-DEGENERATIVE Syringomyelia (-bulbia)

HEREDO-DEGENERATIVE Syringomyelia (-bulbia)

HEREDO-DEGENERATIVE Syringomyelia (-bulbia)

Syringomyelia • Wasting of hand muscles • Dissociated sensory loss (pain and temperature) (ulnar border of hands) • Posterior column (JPS, vibration intact) • Tendon reflexes of LL exaggerated • Plantar extensor/flexor • Wasting, fasciculation of tongue (syringobulbia)

INFLAMMATORY DISEASES (TRANSVERSE MYELITIS) Idiopathic Viral (eg. Herpes simplex, Rabies) Collagen vascular diseases Multiple sclerosis Devic’s disease (Neuro-myelitis optica) Radiation myelopathy

INFECTIONS Poliomyelitis Tuberculosis (Meningitis, Arachnoiditis, Granuloma, Tuberculoma) Syphilis (Meningo-vascular, Tabes dorsalis) HIV HTLV-1 (TSP, HAM) Schistosomiasis

VASCULAR DISORDERS Infarction (Anterior spinal A. thrombosis) Haemorrhage Arterio-venous malformations

NUTRITIONAL DEFICIENCIES Subacute combined degeneration (Vitamin B12 deficiency eg. Pernicious anaemia) Vitamin E deficiency

TOXIC-NUTRITIONAL DISORDERS Lathyrism Konzo (Tropical ataxic neuropathy) LATHYRISM Endemic in India, Bangladesh, and Ethiopia Related to beta-N-oxalylamino-L-alanine (BOAA) Due to excessive consumption of Lathyrus sativus (chicken pea) Minimised by soaking and boiling the legume before cooking

TOXIC-NUTRITIONAL DISORDERS Lathyrism Konzo (Tropical ataxic neuropathy) KONZO Epidemic in Mozambique, Tanzania, Zaire, Central Africa Due to cyanide from insufficiently processed bitter cassava Detoxification impaired because of low protein (sulphur) diet Chronic exposure causes Tropical ataxic neuropathy

SPINAL CORD DISORDERS Noncompressive Compressive

EFFECTS DUE TO COMPRESSION OF Sensory (A) Nerve roots Motor (LMN) Sensory (B) Spinal cord Motor (UMN) Autonomic

SYMPTOMS AND SIGNS Paraesthesiae (N. root/ spinothalamic) (A) Sensory Sensory loss (N. root/ spinothalamic) LMN (at the level of compression) (B) Motor UMN (below the level of compression) Reduced/Absent (at the level) (C) Reflexes Exaggerated (below) /Extensor plantar (D) Autonomic (Bladder, Bowel, Impotence, Sweating disturbances)

DIAGNOSTIC APPROACH • Is it spinal cord compression? • Intramedullary or extramedullary? • Which spinal segment? • Vertebral level? • What is the cause?

REGIONAL LOCALISATION • Foramen magnum/ Upper cervical • Cervical cord • Thoracic cord • Conus medullaris • Cauda equina

CERVICAL CORD Upper limbs  Wasting, weakness UL  Reflexes: absent/ exaggerated  C5: Inverted supinator reflex  Pain, numbness, sensory loss Lower limbs  UMN signs  Sensory loss (spinothalamic/ posterior column)  Lhermitte’s sign

UPPER CERVICAL CORD Additional signs  Down-beat nystagmus  Horner’s syndrome  Trigeminal sensory loss Foramen Magnum  Proximal joint-position loss  Wasting of the tongue  Papilloedema

THORACIC CORD  Girdle pain  Spinothalamic (pain, temperature) loss with a sensory level  Posterior column sensory loss  UMN signs in LL  T8: Beevor’s sign  Sphincter disturbances  Erectile impotence

CONUS MEDULLARIS  Pain radiating down LL  UMN and LMN signs in LL  Dermatomal sensory loss (all modalities)  Sphincter disturbances  Erectile impotence

CAUDA EQUINA  Pain radiating down LL  LMN signs in LL (wasting, weakness)  Dermatomal (sacral) sensory loss (all modalities)  Sphincter disturbances  Erectile impotence

HEREDO-DEGENERATIVE Motor neuron disease (PMA, AML) Spinal muscular atrophy (SMA) Hereditary spastic paraparesis Spino-cerebellar degeneration Fredreich’s ataxia Syringomyelia (-bulbia)

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