lesions of spinal cord

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lesions of spinal cord
2013-09-15 08:15:14

lesions of spinal cord
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  1. deficit resulting from lower motor neuron lesion
    • 1. Flaccid paralysis
    • 2. Muscle atrophy (amyotrophy)
    • 3. Hypotonia
    • 4. Areflexiaconsists of loss of muscle stretch reflexes (MSRs) (knee and ankle jerks) and loss of superficial reflexes(abdominal and cremasteric reflexes).
    • 5. Fasciculations (visible muscle twitches)
    • 6. Fibrillations (seen only on electromyogram)
  2. disease of LMN
    • poliomyelitis - is an acute inflammatory viral infection affecting the LMNs; it is caused by an enterovirus. (RESULTS IN FLACCID PARALYSIS)
    • Progressive infantile muscular atrophy (Werdnig-Hoffmann disease)is a heredofamilial degenerative disease of infants that affects LMNs.
    • Kugelberg-Welander disease (juvenile hereditary LMN disease)appears at 3 to 20 years of age.affects the large girdle muscles first and then the distal muscles.
  3. upper motor neuron lesions
    • 1Spastic hemiparesis with muscle weakness
    • 2. Hyperreflexia (exaggerated muscle stretch reflexes)
    • 3. Clasp-knife spasticity
    • 4. Loss of superficial (abdominal and cremasteric) reflexes
    • 5. Clonusconsists of rhythmic contractions of muscles in response to sudden, passive movements (wrist, patellar,or ankle clonus).
    • 6. Babinski signconsists of plantar reflex response that is extensor (dorsiflexion of big toe).
  4. Ventral corticospinal tract lesion
    mild contralateral motor deficir
  5. Hereditary spastic paraplegia or diplegia
    • bilateral degeneration of corticospinal tract 
    • gradual development of spastic weakness of legs
  6. sensory pathway lesions
    • dorsal column syndrome
    • lateral spinothalmic tract lesion 
    • ventral spinothalmic tract lesion 
    • dorsal spinocerebellar tract lesion 
    • ventral spinocerebellar tract lesion
  7. dorsal column syndrome - signs
    • 1. Loss of tactile discrimination
    • 2. Loss of position (joint) and vibratory sensation
    • 3. Stereoanesthesia (astereognosis)
    • 4. Sensory (dorsal column) dystaxia
    • 5. Paresthesias and pain (dorsal root irritation)
    • 6. Hyporeflexia or areflexia (dorsal root deafferentation)
    • 7. Urinary incontinence, constipation, and impotence (dorsal root
  8. lateral spinothalmic tract lesion
    loss of contralateral pain and temperature sensation one segment below the level of the lesion
  9. ventral spinothalmic tract lesion
    contralateral loss of light touch sensation three of four segments below the level of lesion
  10. dorsal spinocerebellar tract lesion
    ipsilateral leg dystaxia, head to shin test
  11. ventral spinocerebellar tract lesion
    contralateral leg dystaxia, head to shin test
  12. PNS lesion
    • herpes zoster - shingles 
    • Acute idiopathic polyneuritis (Guillain-Barré syndrome)
  13. Acute idiopathic polyneuritis (Guillain-Barré syndrome)
    • follows infectious illness 
    • motor fibers and causes segment demyelination  and walerian degeneration 
    • produces LMN symptoms (muscle weakness, flaccid paralysis, and areflexia).
    • begins with paralysis of lower extremity and progressively goes up 
    • elevated CSF protein, however CSF cell count normal albuminocytologicdissociation).
  14. herpes zoster
    • viral infection 
    • common T5-T10
    • irritation of dorsal root ganglia 
    • 1. pain, itching, and burning sensation 
    • produces the characteristic vesicular eruption in the affected dermatome.
  15. Prototypic disease—amyotrophic lateral sclerosis (AML) Lou Gehring disease
    • usually occurs in persons 50 to 70 years of age.
    • affects twice as many men as women.
    • involves both LMNs and UMNs;
    • either component may dominate the clinical picture.progressive (spinal) muscular atrophy or progressive bulbar palsy refers to an LMN component.
    • pseudobulbar palsy or primary lateral sclerosis refers to a UMN component.