脊 髓 疾 病13

Acute myelitis- Clinical features
• Dyskinesia: spinal shock 2~4weeks
upper motor neuron paralysis
• Sensory disturbance: 损伤以下所有感觉障碍，
恢复较运动慢。
• Autonomic nerves dysfunction: 早期尿潴留(无
急性脊髓炎 (Acute myelitis)
Concept
Acute transverse impairments caused by demyelination or necrosis on white matter of the myeline. Such as: myelitis following infection, myelitis following vaccine inoculation, demyelinative myelitis, necrosis myelitis, para-tumor myelitis.
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Cord impairments-Clinical features
• 脊髓半侧损害 (hemi-transverse impairments):
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Brown-Sequard syndrome 脊髓横贯损害(transverse impairments): spinal shock 1) 高颈髓(C1~4): cervical myelon 2) 颈膨大(C5~T2): cervical enlargement 3) 胸髓(T3~T12): thoracic myelon 4) 腰膨大(L1~S2): lumbar myelon 5) 脊髓圆锥(S3~5和尾节): terminal cone 6) 马尾(cauda equina)
Acute myelitis-Pathology
Every segment may be involved, Range: T3~5, cervical or lumbar segment. Focal or transverse lesions, Findings under naked eyes: 脊髓肿胀，质地 变软，软膜充血渗出，切面灰白质不清， 变性。 Findings under microscope: 髓内血管扩张、 充血，血管周围炎性细胞侵润，神经细胞 肿胀，破裂，消失，白质脱髓鞘，轴突变 性，胶质增生。
The anatomy of the spinal cord 1. External components:
Spinal nerves: 31pairs of nerves were sent out: C8, T12, L5, S5 • The segmental distribution of cutaneous sensory innervation 见图1 图2
The anatomy of the spinal cord 1. External components:



The cord of C1~8 is one segment higher than the correspond spine respectively, T1~8 is two segment higher, T9~12 is three higher, the count-part of lumbar is the 10~12th thoracic vertebra , sacral cord lies in the 12th thoracic vertebra and the 1st lumbar.
Acute myelitis- Pathogeny
• unclear
auto-immune reaction in association with a viral infection or vaccine inoculation 1~4 weeks ago. But there were no detective virus in nervous tissues, also no antibodies in CSF detected.
Cord impairments-Clinical features
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Motor deficits: spastic or flaccid paralysis Disorders of somatic sensation:见图 posterior horn & root: 节段性感觉障碍 posterior horn :节段性分离性感觉障碍 anterior white commissure: 感觉分离现象 spinalthalamic tract:传导束性感觉障碍: Sphincter dysfunctions: paruria and dysporia incontinence or retention (including urination and defecation) Autonomic nervous imbalance
The anatomy of the spinal cord 3.Blood supply
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Anterior spinal artery: which supplies the anterior two-thirds of the cord 供应脊髓全长和脊髓横断面前2/3区域。 Posterior spinal arteries: 供应脊髓全长及脊髓后柱、 后索，脊髓横断面后1/3区域。 Radicular arteries: 根动脉与脊髓前、后动脉吻合， 构成冠状动脉(coronary artery)环围绕脊髓表面， 分出无数小支供应脊髓表面结构及脊髓实质外周 部分的供血。C6、T9和L2处最大，T4和L1为交 界。见图
判定脊髓病灶上界依据
• Tendon reflex change：
C5~6, biceps and brachioradialis C7~8, triceps L2~4, knee jerk S1~2, ankle • 自主神经征： 反射性皮肤划纹症(reflective dermatography) 头颈部立毛反射(pilomotor reflex) 阿司匹林发汗试验(Aspirins weating test) 中断处，均为脊髓病变上界。
Acute myelitis-Clinical features
2. Acute onset, gets to the peak after several hours or 2~3 days. The initial symptoms: Numbness and weakness Backache and girdle sensation The most frequent sites: T3-5,
脊髓横贯性损害推算脊柱节段
分三步走： • 脊髓病变上界=皮节1，
如皮节即感觉障碍平面，T7脊髓病变，上界T6。
• 病变上界脊柱节段=脊髓病变上界n。
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(C1~4, n=0; C5~8, n=1；T1~8, n=2；T9~12, n=3) 本例病变上界脊柱节段T62=T4 。 病变中心层面脊柱节段=病变上界脊柱节段+1 (向下1个层面)。本例为T5 。
The anatomy of the spinal cord 2. Internal components:
ቤተ መጻሕፍቲ ባይዱ
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Gray matter: shape like H. Anterior horn: motor neuron. The fibers are anterior root Posterior horn: Lateral horn in the myelon of C8~L2 and S2~4 White matter: anterior column, lateral column, posterior column
判定脊髓病灶上界依据
• 根性症状：最上位根痛、根性感觉缺失、
节段性肌无力或肌萎缩部位。 • 传导束性感觉缺失平面：皮肤感觉支配三 根定律。见图 Cutaneous sensation is in a segmenttal pattern because of overlap there is no loss of sensation unless three adjacent segments are affected.
脊 髓 疾 病
(Diseases of the spinal cord)
Diseases of the spinal cord


Outline Acute myelitis Compressive myelopathy Syringomyelia Subacute combined degeneration of the spinal cord Motor neuron disease
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Acute myelitis-Clinical features
Characters: 1. The youth & post adolescent, No difference between the two sex. Infection or vaccine inoculation history Inducement of cold, overfatigue, trauma
The anatomy of the spinal cord
1.
External components:



The upper and lower boundary of the cord The capsule The spinal nerves The relation between the cord and spine
The anatomy of the spinal cord 1. External components: