Chronic Spinal Cord Injury

(Lesi Medula Spinalis Khronis)

Darwin Amir
Bgn Ilmu Penyakit Saraf
Fakultas Kedokteran Universitas Andalas

The Spinal Cord

Cervical
spinal erves

Thoracic
spinal
nerves

Conus
medullaris
Cauda equina

Lumbar
spinal nerves

Sacral spinal
nerves

PROYEKSI DERMATOM
DIPERMUKAAN KULIT

Ascending Spinal Cord Tract

Conducts sensory impulses upward
through 3 successive chains of neurons
1st order neuron - cutaneous receptors of
skin and proprioceptors spinal cord or
brain stem
2nd order neuron - to thalamus or
cerebellum
3rd order neuron - to somatosensory
cortex of cerebrum

Ascending Spinal Cord Tract

The Spinal Cord

vertebra

spinal
cord
spinal
nerve

Cross Section of Spinal Cord

White matter:
Myelinated axons

forming nerve
tracts
Fissure and sulcus
Three columns:

Ventral
Dorsal
Lateral
(see later for white matter
pathways)

Gray matter:
Neuron cell cell

bodies, dendrites,
axons
Horns:
Posterior (dorsal)
Anterior (ventral)
Lateral

Commissures:
Gray: Central canal
White

The Nervous System

The Spinal Cord-part of the CNS found within the
Spinal column
The spinal cord communicates with the sense
organs and muscles below the level of the head
Bell-Magendie Law-the entering dorsal roots
carry sensory information and the exiting ventral
roots carry motor information to the muscles and
Glands
Dorsal Root Ganglia-clusters of neurons outside
the spinal cord

Nerve Pathways into the Spinal Cord

sensory
pathway

motor
pathway

Somatic Sensory Pathway

CORTICOSPINAL
TRACTS

Symptoms and Signs

Must

be mastering in mind

Start

by understanding anatomy and

physiology of the Nervous System

Dons

forget the of CNS systematically

- Anatomy of CNS
- Physiology of CNS
- Pathophysiology of the Disease
- The steps to make the diagnosis

Sensory disturbances
Soft touch, pain, temperature,

position, vibration impaired below the

level of lesion

Band like radicular pain/segmental

paraesthesia at the level of lesion

localised vertebral spine pain-

destructive lesions

Motor disturbances
Paraplegia/quadriplegia

Acute-flaccid / Areflexic-spinal shock

latter-hypertonic / hyper reflexic, loss
of superficial reflexes, Babinski +,
flexor/extensor spasm
Extension of hip, knee occurs in high
spinal & Incomplete lesion

Motor disturbances
Flexion of hip , knee occur in low

spinal & complete lesion

At the level of lesion paresis,

atrophy, fasciculations,and
areflexia(LMN signs) in a segmental
distribution because of damage to
the anterior horn cells and ventral
roots

Autononomic disturbances

initially atonic, latter spastic bladder,

rectal sphincter disturbances
orthostatic hypotension
trophic skin changes
anhydrosis
impaired temperature control
vasomotor instability
sexual disturbances
I/L horner syndrome

Causes of Chronic Lesion

Tumour
Multiple sclerosis
Vascular disorders
Spinal epidural hematoma/abscess
Auto immune disease
Herniated intervertebral disc

12 Deficiences

Combine degeneration of B

Complete spinal cord transection

(Transverse myelopathy)

Complete spinal cord transection

(Transverse myelopathy)
All

acsending tracts from below the level of the

lesion and all descending tract from above the level
of lesion interrupted. Motor, sensory, autonomic
functions below the level of lesion disturbed

Causes

tumour

multiple sclerosis

vascular disorders
spinal epidural hematoma/
spinal epidural abscess herniated intervertebral disc
auto immune disease

Central spinal cord lesion

Spinal

cord damage starts centrally

and spreads centrifugally

Decussating

fibers of spinothalamic
tract involved initially

Thermo

anaesthesia, analgesia in a
vest like or suspended bilateral
distribution with preservation soft
touch sensation and
proprioception--- dissociation of
sensory loss

Central spinal cord lesion

Forward

extension of disease anterior

horn cells involved segmental
neurogenic atrophy, paresis, areflexia
Lateral extension
I/L Horner syndrome
Kypho scoliosis
Spastic paralysis
Dorsal extension
I/L Position sense, vibratory loss

Central spinal cord lesion

Extreme

venterolateral extension
thermo anaesthesia, analgesia with
sacral sparing

Neuropathic
Pain

arthropathy

Posterior column disease

Posterior column disease

Tabes

dorsalis-tabetic neuro syphilis,

progressive locomotor ataxia
Impaired vibration and position sense,
and decreased tactile localisation
Lability of mechanical sensation threshold,
tactile & postural hallucinations,
persistence of mechano receptor
sensation, disturbances in the knowledge
of extremity movement and positions
(temporal & spatial disturbances)
Sensory ataxia in dark, Romberg (+)

Posterior column disease

Ataxic

/ stomping/ double tapping gait

Positive sink sign
In tabes dorsalis lancinating pain, urinary
incontinence, Negative patellar and ankle
DTR, hypotonic limb, hyper extensible
joints
abdominal, laryngeal crises, impaired
light touch perception, Argyll robertson
pupil, optic atrophy, ptosis,
ophthalmoplegia

Posterior column disease

Lhermitte sign or barber chair syndrome due
to increased mechano sensitivity
Truncal and gait ataxia : also seen in mets
causing cord compression
Impaired conduction in dorsal spino cere
-bellar tract may be a primar manifestation of
epidural spinal cord compression-lower
extremity dysmetria and gait ataxia.
Pt usually have thoracic spine compression
due to selective vulnerability of spinocere
bellar tract in thoracic spine to compres -sive
ischemia

Hemisection of the spinal cord

( Brown sequard syndrome)

Hemisection of the spinal cord

( Brown sequard syndrome)
Loss

of pain, temp C/L to the hemisectioninterruption of crossed spino thalamic tract

Loss of proprioception interruption of
ascending fibers of posterior column
Spastic weakness due to interruption of
descending cortico spinal tract
Segmental LMN signs and sensory changes
at the level of lesion due to damage of the
roots and anterior horn cells at the level
of lesion

INNERVATION OF
AUTONOMIC NERVOUS
SYSTEM

Thank you Brain

For all you remember

What you forgot was my fault