Spinal Cord Deseases

Na Shao
AIMS OF THE SESSION

 Basic anatomy

 Common signs, symptoms

 Clinical features of spinal cord disease.

ANATOMY

 Spinal cord lies within protective

covering of vertebral column.

 Begins just below foramen

magnum of the skull, continuous
with medulla of brain.

 Ends below at lower border of

L1 in adult; at birth at level of L3.
 脊神经根

cervical
nerves
C1-8

thoracic
nerves
T1-12

L1-5
lumbar
nerves
S1-5
sacral
nerves
coccygeal
nerves
 Inside and outside the structure
of the spinal canal
Three layer epidural space
dura mater
• dura mater, subdural space
• arachnoid, arachnoid
subarachnoid
• pia mater
Three spaces
• epidural space
• subdural space
• subarachnoid
space
Cross-sections of the spinal cord

posterior root

White
matter
Gray matter ventral root

spinal nerve
 The internal structure of the spinal cord
posterior cord
posterior horn posterior spinocerebellar tract

corticospinal tract
lateral cord

anterior
spinocerebellar
tract

lateral spinothalamic
anterior tract
funiculus

anterior horn
corticospinal tract
anterior spinothalamic tract
Actue transverse myelitis
 case 1
Case Information ：Mr. Zhang ，38 years old

Chief Complaint ： Both lower extremities numb,

powerlessness 1 day .
Is history：2 weeks before the incidence of fever, upper
respiratory tract infection history. 1 day to nearly
double lower extremity numbness, powerlessness. 2-3
days after the emergence of thoracic level 4 band and
accompanied by a sense of thoracic nerve root pain 3-
5 plane, 4 the following thoracolumbar level of sensory
loss, double-0 lower limb muscle strength, tendon
reflexes disappear and become dysfunction.
The main examination:

Thoracic MRI examination:

4-5 abnormal chest plane signal change.
Cerebrospinal fluid examination:

 Normal pressure

 WBC count increased slightly to cell-based

 mildly elevated protein content

 sugar and normal chloride.

With the focus on the difficulties
 Cause?

 Clinical manifestation?

 Diagnosis based on?

 Concept?

 Sections of the spinal cord characterized by inflammation?

 Differential diagnosis?

 Treatment?
Acute transverse myelitis

Concept:

Non-specific inflammatory demyelinating

disease located in spinal cord , resulting in

acute transverse spinal cord damage.

 Epidemiological features

 Age: mostly young and middle-aged

 Season: intersection of spring, autumn and winter seasons
 Sex: There was no significant difference
Etiology
 Not yet clear
 Autoimmune diseases
• the majority of patients with upper respiratory tract disease before,
such as diarrhea infection history;
• serum influenza virus, measles virus and other virus antibody levels
was rised;
• lesions in the spinal cord and cerebrospinal fluid was not isolated the
virus.
 Pathology
• Can be extended to any segment of the spinal
cervical（10-15%）
cord, thoracic (70-85%) is the most common,
followed by cervical spinal cord (10-15%) and
thoracic（70-85%）
lumbar sacral (8-12%);
• Most involved soft meningeal , gray matter and
white matter;
• Lesions often confined to a segment of the spine;
lumbar sacral
• Integration of spinal cord lesions or more （8-12%）

segments scattered lesions are a rare;

Pathology

The naked eye:

Damage to the spinal cord segment is swelling,

softened, congestive meningeal and inflammatory

exudate.
Pathology

Optical microscope:

 Congestive blood vessels to expand, inflammatory cell

infiltration, by lymphocytes and plasma cells mainly;

 the nerve cells inside Gray matter swelling , rupture and

disappear ；

 White matter demyelination and axon degeneration;

 The hyperplasia of glial cells can be seen in the Lesions
clinical manifestation
Premonitory symptoms:
(1) Disease for a few days ago or 3 weeks
before, there are often fever, diarrhea or
upper respiratory tract infection and
history of fatigue, cold history. (can cause
autoimmune response)
（2）Both lower extremities numb sense and
to feel weak , a sense of band-segment
disease or root pain.
clinical manifestation

Incidence:
（1）Acute onset, often for several hours to several days to

complete the development of paraplegia.

（2）Following is a flat lesion , movement, feeling, reflection

and the autonomic nervous system dysfunction.

clinical manifestation

Dyskinesia:
1st: Spinal shock: General for 1-2
weeks, lower motor neuron
paralysis, urine retention .

2nd: Spinal cord recovery period:

upper motor neuron damage,
incontinence.
Sense of obstacles:
following disease segments, all sense of

loss, and may be associated with

hypersensitivity or band-like area feel

abnormal.

Autonomic nervous system dysfunction:

（1）Obstacles to the toilet: urine retention

will be, incontinence

（2）dry skin, less (no) sweat , scaling, and so
on.
With different segments of spinal cord injury, the 高颈段
clinical features of paralysis

颈膨大
（1）Cervical:
High cervical: limbs central paralysis
Cervical enlargement: Both upper limbs flaccid paralysis ,both 胸段
lower limbs Central paralysis

（2）Thoracic: Both lower limbs Central paralysis

腰段
（3）Waist: Both lower limbs flaccid paralysis

（4）Sacral: Only occur saddle area (perineum) 骶段

movement, sensory disturbance , Anus
and the cremaster reflex disappear .
Special type of inflammation of the spinal cord

(1) acute ascending myelitis：

 acute-onset;
 a rapid increase in a few hours or 1-2 days,;
 paralyzed from the upper or lower extremities
quickly spread to the medulla oblongata at the
disposal muscles;
 difficulty swallowing occur, dysarthria, respiratory
muscle paralysis and even death.
supplementary examination

lumbar puncture
 normal cerebrospinal fluid pressure, the
appearance of colorless and transparent;
 cells, protein content was normal or mildly
elevated with lymphocyte predominance;
 sugar, chloride is normal.
supplementary examination

Imaging (MRI):
show the spinal cord lesion
enlargement (swelling);
multiple interlocking sheet-like
spots or abnormal signal change.
Diagnosis

Diagnosis based on
 1-3 weeks before the disease have a history of
infection;
 acute onset and rapid progress to completely
Trans-cord injury;
 below the level of disease movement, feeling,
reflection, the autonomic nervous system
dysfunction;
 supplementary examination: cerebrospinal
fluid, MRI, Electrophysiology, and so on.
differential diagnosis

 Periodic paralysis: A similar attack in the past history, no feeling,

Bowel and Urine dysfunction ,lower serum potassium (K+),

electrocardiogram showed changes, rapid recovery after the

potassium supplement.

 Acute Guillain-Barre syndrome: A period of shock in acute myelitis

similar to the feeling of obstacles for the peripheral type, no Bowel and

Urine dysfunction , cerebrospinal fluid show protein - cells isolated

phenomenon.
spinal cord compression:

spinal trauma

disc herniation

tuberculosis

cancer
图 1
spinal epidural hematoma

abscess

check-spinal deformity

X-ray and MRI can identify the spine

图 2
Figure 3: extramedullary tumor Figure 4: intramedullary tumor
Differential diagnosis

 optic myelitis: optic neuritis has clear symptoms and signs.

 syphilitic myelitis: have a rule of nature or history, syphilis

serology testing positive.
Treatment principles

a. to reduce spinal cord injury

b. to prevent complications
c. to promote functional recovery of spinal cord
d. to reduce the after-effects
drug treatment
a) diuretics dehydration: 20% mannitol (1-2g/kg / sub-2-3 times / day, 4-6
days MS).

b) adrenal cortex hormones: dexamethasone (10-20mg) or hydrocortisone

to Song (200 -- 300mg), times / day, 10-intravenous drip for 20 days for a

course of treatment.

c) strong pine-chip (30-60mg / day, and Dayton services), the weekly

reduction 5mg ,5-6 weeks out gradually.
drug treatment

d) antibiotics: with the lungs or urinary tract infection, the selection of

sensitive, sensitive and effective antibiotics.

e) neuroprotective agents: energy mixture (coenzyme A, ATP, and so

CDPC), high-dose vitamins B, 10-inosine injection for 20 days for a

course of treatment.

f) the respiratory tract usually keep and maintain respiratory function.

g) the discretion to choose plasma exchange.

rehabilitation
2007-09-10 2007-10-08
Review and compare before and after treatment
prognosis
 precursor symptoms: before the disease have fever infections, such

as history, the better the prognosis.

 the extent of damage to the spinal cord:

Or a single part of the Trans-damage, a better prognosis;

Up myelitis or diffuse damage, poor prognosis;

 complications: there are serious complications, poor prognosis;

 hormone therapy: a sensitive, good prognosis;

 spinal shock: a long, poor prognosis.

summary

 acute transverse myelitis concept?

 based on the diagnosis?

 the segment features myelitis?

 the main differential diagnosis?
 the principle of treatment?
Thank you!