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Spinal cord lesions

Forms of syringomyelia

Spinal cord overview

Introduction hemisection

By: Ahmed Mourad

  • The spinal cord is connected to the brain and is about the diameter of a human finger.
  • It descends down the middle of the back.
  • Protected by the bony vertebral column.
  • Surrounded by CSF
  • Consists of millions of nerve fibers

M

S

Spinal Nerves

Cervical Nerves

(Nerves in the neck)

  • C1-C7
  • supply movement and feelings to the arms, neck and the upper trunk.
  • Control breathing

Thoracic nerves

(Nerves in the upper back)

  • T1-T12
  • Supply the trunk and abdomen

Lumbar and Sacral nerves

(nerves in the lower back)

  • L1-L5

  • S1-S5
  • Supply the legs, bladder, bowel and sexual organs

Spinal cord injuries

Syringomyelia

(sear-IN-go-my-EEL-ya)

By: Ahmed AbdelAzim

Draining the syrinx

(shunt)

  • Using a catheter, drainage tubes, and valves.
  • Used for both communicating and non-communicating forms.
  • Halt the progression of symptoms and relieve pain
  • It can cause injury to SC, infection, blockage or hemorrhage.
  • Left as last resort.

Trauma-related syringomyelia

Treatment

  • Surgical approach is to operate at the level of initial inury.
  • Expand the space around the SC.
  • Decrease fluid volume.
  • This is done by removing the scar tissue and adding a patch to expand the dura.

Definition

Chiari malformation

  • A disorder in which a cyst (syrinx) forms within the spinal cord.

  • Syrinx expands and elongates over time.

  • As a syrinx widens it compresses and injures nerve fibers.

  • Information are lost.

Tumor-related syringomyelia

Remove the tumor

THANK YOU

  • Lower motor neurons of the AHCs are damgaed.
  • Muscle wasting and weakness begins in the hands and then forearms and shoulders.
  • Tendon reflexes are lost.
  • Respiratory muscle involvement

Motor features

  • Syrinx extends into the medulla of the brainstem.
  • The cranial nerves become affected:
  • Trigeminal nerve.
  • Vestibulocochlear nerve.
  • Facial, palatal and laryngeal nerve palsy.
  • Hypoglossal nerve.

Syringobulbia

  • Most serious form.
  • Cerebellum and brain stem herniate, through the foramen magnum and into the spinal cord.
  • Part of the 4th ventricle may also protrude into the spinal cord.
  • Rarely can enter an occipital encephalocele.
  • The covering of brain/spinal cord can protrude through an abnormal opening in the back of the skull.
  • Causes severe neurological defects.

Type III

Clinical Presentation

  • Extension of cerebellar tonsils into the foramen magnum.
  • Does not involve the brain stem
  • May not cause symptoms
  • Most common form.
  • First noticed in adolescence/ adulthood.
  • Can be acquired.
  • Cerebellar hypoplasia.
  • Rare form
  • Cerebellar tonsils are in a normal position.
  • Parts of cerebellum are missing.
  • Portions of the skull and SC may be visible.

Symptoms

  • Begins between the ages 25-40
  • Worsen with straining.

Type I

Type IV

  • Extension of both cerebellar and brain stem tissue into the foramen magnum.
  • Cerebellar vermis may be partially complete/ abscent.
  • Usually accompanied by a myelomeningocele

(Classic CM)

Type II

Arnold-chiari malformation

  • Pain and temperature sensation are lost.
  • One side may be affected more than the other.
  • Dysaesthesia is common.
  • Light touch, vibration and position senses in the feet are affected.

(Communicating syringomyelia)

Chiari malformation

Sensory features

  • Appear months/years later.
  • Primary symptom is pain
  • May occur on one or both sides of the body.
  • Can affect sweating, sexual function, and, later bladder and bowel control.

Symptoms

  • Complication of trauma.
  • Meningitis.
  • Hemorrhage.
  • Tumor.
  • Arachnoiditis.

Non communicating syringomyelia

Distribution

Ascending and descending tracts

Traumatic

Compression

Non-traumatic

  • Blow to the spine that fractures, dislocates or crushes one or more of the vertebrae.

  • Gun shot or knife wound.

  • Damage may occur over days or weeks because of bleeding, swelling, inflammation or accumulation in or around the spinal cord
  • Arthritis, cancer, inflammation, infections or disc degeneration of the spine.

  • Nerve cell death.

  • Disruption of nerve pathways.

  • Demyelination, or destruction of the protective insulation surrounding the axons.
  • Bone compression

  • C.T compression

  • Hematoma

  • Tumors

  • Abscess (pocket of puss)

  • Ruptured or herniated disks

  • Sudden compression

Brown sequard syndrome

  • Rare spinal disorder

  • Results from injury to one side of the spinal cord

  • Spinal cord is damaged, but not severed completely

Manifestation

Characteristics

  • Injury to the spine in the region of neck or back mainly by puncture wound that damages the spine and causes symptoms to appear due to lesion of:

  • UMN pathway of the corticospinal tract
  • One or both dorsal columns
  • Spinothalamic tract

Treatment

  • Directed at the pathology causing the paralysis:

  • Gunshot/ knife wound treat life threatening conditions.
  • Spinal fracture identified and treated appropriately.

  • Steroid to decrease cord swelling and inflammation.

Complete Transection

THANK YOU

  • Damage of nerves inside the vertebral column
  • Paralysis

Causes

Trauma

  • 1. RTA (44%)
  • 2. violence (24%)
  • 3. falls (22%)
  • 4. sports (8%)

Pathophysiology

Medication

Ongoing

Rehablitation

  • Spinal Shock
  • Long-term

2ry Injury

1ry Injury

Treatment

Symtoms

Emergency=Immobilization

  • Response to 1ry Injury
  • Starts minutes after initial injury
  • Can last for weeks
  • Target for therapeutic intervention
  • Acute compression
  • Laceration
  • Distraction

methylprednisolone

Protective Mechanisms

Cascade of Cellular Events

1. Maintaining ability to breathe

2. Preventing shock

4. Avoidstool or urine retention, respiratory or cardiovascular difficulty and formation of deep vein blood clots in the extremities

5. Sedation might be administered

Acute Treatment

  • Medication
  • Surgery

4-Neuro-Exam

3-MRI

2-CT

1-X-Ray

Diagnostic Techniques

Rule Out

Diagnosis

Anterior Cord Syndrome

It is due to vascular region at the anterior spinal artery

Complete motor defects below the lesion

Intensity of sensory deficits is due to the level of involvement in the spinal cord

Spinal cord injuries

Lateral cord syndrome

Treatment

It takes place due to compression of the nerve

Symptoms are pain, numbness or tingling in the back and legs

It can takes place without spinal stenosis

  • Anterior cord syndrome
  • Lateral cord syndrome
  • Posterior cord syndrome
  • central cord syndromre

Intitial treatment is high dose steroid called methylpredinosolone

Different types of treatment are then used later on as physiotherapy sessions

In some cases surgical operations are required

THANK YOU

Central cord syndrome

White matter injury of the spinal cord

Disproportionate motor weakness in the upper extremeties

Variable amount of sensory loss below the level of injury

Antiedema treatment in the first 24 hours

Posterior cord syndrome

Infarction in the posterior spinal artery

Neurological symptoms are progressed and hypoventilation coma is developed

Diagnosed by MRI or angiography

Any questions?!

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