神经病学英文课件：02 SPINAL CORD
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● Electrophysiology: VEP nl, SEP nl or more decreased
Causes of Spinal Cord Disease
Trauma Cord compression Vascular cord lesions Transverse Myelitis (MS, Viral infection, SLE, Syphilis) Metabolic and Toxic Cord
31 Segments of related spinal cord Spinal nerves vs Segment of spinal cord Cervical enlargement C5-T2, Lumbar
enlargment L1-S2, Conus medullaris, Cauda equina 3 connected tissue layer
Laboratory finding
●CSF: Normal pressure, WBC: 20~200X106/L. Lymph. Prot: nl or slight increased: 0.5~1.2g/L, Glu, Cl normal
● MRI: edema & high signal,T1,T2 CT: r/o struture lesion X ray: spinal X ray nl,
● Acute, subacute ( 2~6 weeks), chronic ( >6 weeks)
●T3~T5 (poor bld supply)
Clinical Features of Acute
Transversive Myelitis
Acute onset: several hours—2~3 days– complete paraplegia Motor: spinal shock, most 2~4 wk, muscle tone decreased, areflex, no Babinski Sensory: segmental damage all modalities of sensory Autonomic function: early retention— bladder Acute ascending myelitis Demyelinative myelitis: MS spinal type， NMO
Introduction
Blood supply of the spinal cord
Ant. Spinal artery Post. Spinal artery
ห้องสมุดไป่ตู้
Introduction
Clinical feature of spinal lesion
Motor( upper & lower motor neuron) Sensory( sensory level) Autonomic dysfunction ( bladder & bowel)
Clinical Localization of the spinal lesion
Brown-Sequard syndrome Transversive myelopathy Spinal Shock
Introduction
Segmental damage of the spinal cord
Etiology & Pathology
● The locus of a limited number of infective and noninfective inflammatory processes, some causing selective destruction of neurons, others involving the meninges and white matter or leading to a necrosis of both gray and white matter.
parasitic,etc III. Myelitis of non infectious inflammatory
type
Postinfectious and postvaccinal Acute and chronic relapsing multiple sclerosis Neuromyelitis Optica （NMO） Lupus angitis
disease( SCD) Intrinsic Cord Lesions
( Tumor, Syrinx)
Myelitis
Classification of Inflammatory Disease of the Spinal Cord
I. Viral Myelitis II. Myelitis secondary to bacterial, fugal,
C1-4: U&LE UMNL (quadriplegia) C5-T2:UE LMNL, LE UMNL T3-12: LE UMNL ( paraplegia) L1-S2: LE LMNL S3-5:No paralysis, no pyramidal sign Co: Similar to above
Introduction
Structure from inside
H type gray matter
Columns Laminas
White matter
Columns: fasciculus gracilis, fasciculus cuneatus
Tracts: e.g. corticospinal tract
Disease of the Spinal Cord
Introduction
Structure from outside
31 pairs of spinal nerves ( Cervical, Thoracic, Lumbar,Sacral, Coccygeal )
C1-8, T1-12, L1-5, S1-5, Co1
Causes of Spinal Cord Disease
Trauma Cord compression Vascular cord lesions Transverse Myelitis (MS, Viral infection, SLE, Syphilis) Metabolic and Toxic Cord
31 Segments of related spinal cord Spinal nerves vs Segment of spinal cord Cervical enlargement C5-T2, Lumbar
enlargment L1-S2, Conus medullaris, Cauda equina 3 connected tissue layer
Laboratory finding
●CSF: Normal pressure, WBC: 20~200X106/L. Lymph. Prot: nl or slight increased: 0.5~1.2g/L, Glu, Cl normal
● MRI: edema & high signal,T1,T2 CT: r/o struture lesion X ray: spinal X ray nl,
● Acute, subacute ( 2~6 weeks), chronic ( >6 weeks)
●T3~T5 (poor bld supply)
Clinical Features of Acute
Transversive Myelitis
Acute onset: several hours—2~3 days– complete paraplegia Motor: spinal shock, most 2~4 wk, muscle tone decreased, areflex, no Babinski Sensory: segmental damage all modalities of sensory Autonomic function: early retention— bladder Acute ascending myelitis Demyelinative myelitis: MS spinal type， NMO
Introduction
Blood supply of the spinal cord
Ant. Spinal artery Post. Spinal artery
ห้องสมุดไป่ตู้
Introduction
Clinical feature of spinal lesion
Motor( upper & lower motor neuron) Sensory( sensory level) Autonomic dysfunction ( bladder & bowel)
Clinical Localization of the spinal lesion
Brown-Sequard syndrome Transversive myelopathy Spinal Shock
Introduction
Segmental damage of the spinal cord
Etiology & Pathology
● The locus of a limited number of infective and noninfective inflammatory processes, some causing selective destruction of neurons, others involving the meninges and white matter or leading to a necrosis of both gray and white matter.
parasitic,etc III. Myelitis of non infectious inflammatory
type
Postinfectious and postvaccinal Acute and chronic relapsing multiple sclerosis Neuromyelitis Optica （NMO） Lupus angitis
disease( SCD) Intrinsic Cord Lesions
( Tumor, Syrinx)
Myelitis
Classification of Inflammatory Disease of the Spinal Cord
I. Viral Myelitis II. Myelitis secondary to bacterial, fugal,
C1-4: U&LE UMNL (quadriplegia) C5-T2:UE LMNL, LE UMNL T3-12: LE UMNL ( paraplegia) L1-S2: LE LMNL S3-5:No paralysis, no pyramidal sign Co: Similar to above
Introduction
Structure from inside
H type gray matter
Columns Laminas
White matter
Columns: fasciculus gracilis, fasciculus cuneatus
Tracts: e.g. corticospinal tract
Disease of the Spinal Cord
Introduction
Structure from outside
31 pairs of spinal nerves ( Cervical, Thoracic, Lumbar,Sacral, Coccygeal )
C1-8, T1-12, L1-5, S1-5, Co1