Features
Features:

Product Tour >

Edraw AI >

Paid Plans:

Individuals >

Business >

Eduaction >
Resources
Blog

History

How-tos & Tips

Discovery

Biography

Business Analysis

Examples

AI concept Map

Free AI Mind Map Generator

Onenote Mind Map

Bcg Matrix Examples

Nike Marketing Strategy

Unilever SWOT Analysis

Make Mind Maps in Google Docs

Guide

FAQs

What's New

Resource Center
Templates
All Templates

Brain Storming Templates

Strategy and Planning Templates

Project Management Templates

Product Management Templates

Human Resources Templates

Agile Workflow Templates

Marketing Templates

Education Templates

Fun and Games Templates

User Gallery
Download
Pricing
Enterprise

MindMap Gallery Neurology Chapter 5 Spinal Cord Diseases

Neurology Chapter 5 Spinal Cord Diseases

This is a mind map about Chapter 5 of Neurology: Spinal Cord Diseases, which mainly includes an overview, acute transverse myelitis, spinal cord compression, etc.

Edited at 2024-03-25 23:38:03

PlotWizard

Recent works View more works>>

Neurology Chapter 5 Spinal Cord Diseases

PlotWizard

Recent works View more works>>

Recommended to you
Outline

Neurology Chapter 5 Spinal Cord Diseases

Overview

Anatomy and Physiology

External structure: divided into 31 segments (8 12 5 5 1); the cervical spinal cord segment is 1 vertebra higher than the cervical vertebrae, the upper and middle thoracic cords are 2, the lower thoracic cord is 3, and the lumbar cord is located at the 10th to 12th thoracic vertebrae. , the sacral cord is located at the 12th thoracic vertebra and the 1st lumbar vertebra

internal structure

Gray matter: front horn → movement of trunk and limbs; posterior horn → relay of sensory information; C8~L2 lateral horn → spinal sympathetic nerve center; S2~S4 lateral horn → spinal cord parasympathetic nerve center

White matter

Ascending fiber tracts/sensory conduction tracts: ① fasciculus gracilis and fasciculus cuneus (deep sensation, fine touch); ② anterior and posterior spinocerebellar tracts (regulation of movement and posture); ③ lateral and anterior spinothalamic tracts (pain, temperature, and touch pressure)

Descending fiber tracts/motor conduction tracts: ① Lateral and anterior corticospinal tracts (trunk and limb movements); ② Rubrospinal tract (controls flexor muscles, coordinates limb movements); ③ Vestibulospinal tract (controls extensor muscles, regulates body balance ; and head and neck movements → nystagmus, head and eye reflexes)

blood supply

Arteries of the spinal cord

Anterior spinal artery: originates from the intracranial part of the vertebral arteries on both sides, forming a complete and continuous longitudinal blood vessel, descending along the anterior median fissure, and giving off 3 to 4 branches of the commissural arteries (terminal arteries) per centimeter to supply the spinal cord. 2/3 area in front of the cross section

Posterior spinal artery: originates from the intracranial part of the ipsilateral vertebral artery, one on the left and one on the left (it does not form a complete and continuous longitudinal blood vessel, and blood supply disorders are less likely to occur), descends along the posterolateral groove, and supplies the cross section of the spinal cord. Back 1/3 area

Radicular artery: comes from the vertebral artery, inferior thyroid artery, intercostal artery, lumbar artery and other branches along the spinal nerve root and enters the spinal canal. It then divides into the anterior radicular artery and the posterior radicular artery, which anastomoses with the anterior spinal artery and posterior spinal artery respectively to form the coronary artery. Arterial ring; the junction of two adjacent root arteries is often an area prone to ischemia (especially T4 and L1)

Veins of the spinal cord: Anterior spinal veins Posterior spinal veins → Vertebral venous plexus Spinal reflex

Stretch reflex/extension reflex: tendon reflex (sudden stretch), postural reflex (continuous stretch)

Flexion reflex: When a limb is subjected to noxious stimulation, the flexor muscles contract rapidly to escape this stimulation. Function: ① Relay station of the upper and lower conduction pathways; ② Reflex center

Lesion location

incomplete spinal cord damage

Anterior horn damage: segmental lower motor neuron paralysis

Dorsal horn damage: ipsilateral segmental dissociated sensory disorder (loss of pain and temperature sensation, preserved touch)

Damage near the central canal: bilateral segmental symmetrical dissociated sensory impairment

Lateral angle damage: sympathetic nerve damage, parasympathetic nerve damage

Anterior cord damage: Damage to the anterior spinothalamic bundle can cause gross tactile impairment below the level of the contralateral lesion; irritating lesions can cause indescribable diffuse pain and hyperesthesia below the contralateral level.

Posterior cord damage: deep sensory and fine tactile impairment, sensory ataxia; irritating lesions may cause electric shock-like pain

Lateral cord damage: Upper motor neuron paralysis and pain and temperature disturbance below the level of the lesion in the contralateral limb

Spinal tract damage: selective invasion of individual conduction tracts in the spinal cord

Hemilateral damage to the spinal cord - hemisection syndrome/Brown-Sequard syndrome: ipsilateral upper motor neuron paralysis below the lesion level, deep sensory and fine tactile impairment, vasomotor dysfunction, and contralateral pain and temperature impairment ; Seen in extramedullary tumors and spinal cord trauma

Transverse spinal cord injury

Main symptoms: various sensory loss below the level of injury, upper motor neuron paralysis, sphincter disorder; symptoms of spinal shock may occur in the acute stage (flaccid paralysis below the level of injury, decreased muscle tone, weakened tendon reflexes, negative pathological reflexes, Urinary retention), which turns into central paralysis after 2 to 4 weeks (increased muscle tone, hyperreflexia, positive pathological reflexes, reflex urination)

Positioning (segment)

High cervical cord (C1~C4): upper motor neuron paralysis of the limbs, and complete sensory loss on both sides below the level of the lesion.

/Hypolysis, urinary and defecation difficulties, no sweating in the limbs/trunk, often occipital pain and limited head movement; diaphragm paralysis occurs when the C3~C5 segment is damaged.

Neck enlargement (C5~T2): lower motor neuron paralysis of both upper limbs and upper motor neuron paralysis of both lower limbs; various sensory loss below the lesion level, segmental hypoesthesia/loss of sensation in the upper limbs, may be present Radicular pain radiating to shoulder/upper extremity; Horner syndrome occurs when lateral horn cells are damaged at C8 and T1 segments

Thoracic cord: In case of transverse injury, both upper limbs are normal but both lower limbs are abnormal; the level of sensory impairment is an important basis for determining the injured segment; when the lesion is located at T10~T11, it can cause weakness in the lower half of the rectus abdominis. When you raise your head, you can see that the umbilicus is pulled upward by the upper part of the rectus abdominis muscle (Beevor's sign is positive)

Lumbosacral enlargement (L1~S2): lower motor neuron paralysis of both lower limbs, various sensory defects and sphincter disorders of both lower limbs and perineum

Conus medullaris (S3~S5 caudal cord): no paralysis of the lower limbs, no pyramidal tract signs; manifested by sensory impairment in the sellar area, loss of anal reflex, sexual dysfunction, and true urinary incontinence

Cauda equina nerve roots (10 pairs of nerve roots): attention and identification of conus medullaris lesions

Section 1 Acute transverse myelitis (acute transverse myelitis)

[Definition] Acute transverse myelitis due to autoimmune reaction caused by various infections; it is the most common myelitis in clinical practice; it is characterized by paralysis of the limbs below the level of the lesion, conductive tract sensory impairment, and bowel obstruction. feature

[Pathology] Any segment of the spinal cord can be involved, but the thoracic spinal cord (T3~T5) is the most common; usually limited to one segment, multi-focal fusion/multi-segment scattered lesions are rare; if there are more than 2 diffuse lesions in the spinal cord Sexual lesions are called "disseminated myelitis"

[Clinical manifestations]

[Auxiliary examination] cerebrospinal fluid examination (basically normal, cervical compression test is smooth), electrophysiological examination (MEP can be used as an indicator to judge efficacy and prognosis), imaging examination (MRI)

[Diagnosis] ① Acute onset of spinal cord motor, sensory, and autonomic nervous system dysfunction; ② Symptoms and signs involving both sides, but not necessarily symmetrical; ③ There is a clear sensory level; ④ Mild leukocytosis in cerebrospinal fluid; ⑤ Spinal cord MRI shows Intramedullary non-space-occupying abnormal signal and may exclude evidence of spinal cord compression

[Differential diagnosis] Acute epidural abscess, spinal cord hemorrhage, acute infectious polyneuritis, periodic paralysis, spinal cord compression

【treat】

First, it is necessary to rule out the possibility of myelitis caused by other causes; for non-specific acute myelitis, the following methods can be used

Section 2 Spinal cord compression

[Cause] Tumor (the most common in the extramedullary dura is schwannoma, the most common in the intramedullary is glioma, and the most common in the extradural is metastasis), inflammation, trauma, degeneration, congenital diseases, blood diseases

[Clinical manifestations]

symptom

Acute onset, complete loss of spinal cord function within hours to days; often manifested as transverse spinal cord injury, resulting in spinal shock

Chronic

Nerve root symptoms: The most common first symptom of extramedullary intradural tumors; the main manifestations are radicular pain (aggravated by coughing and exertion) and localized sensory/motor impairment

Movement disorder: spastic paralysis of the limbs below the level of the lesion; when the spinal cord damage is incomplete in the early stage, it may manifest as extension paraplegia, and in later stages, it may manifest as flexion paraplegia.

Sensory impairment: Sensory impairment in extramedullary lesions develops from bottom to top until the compressed segment; in the early stage of intramedullary lesions, dissociated sensory impairment occurs in the area dominated by the lesion segment. When the spinothalamic tract is involved, the sensory impairment develops from the lesion segment downwards. Preservation of area sensation until final involvement ("sellar avoidance")

Abnormal reflexes: The tendon reflex corresponding to the compressed segment is weakened/disappeared, the tendon reflex below the compression plane is hyperactive, the shallow reflex disappears, and pathological reflexes appear

Autonomic nervous system symptoms: Intramedullary lesions can cause bowel obstruction in the early stage, while extramedullary lesions often occur in the later stages; there may be nutritional changes in the skin below the lesions.

Symptoms of spinal irritation: seen in epidural lesions; manifested as local spontaneous pain, percussion pain, and limited movement in the spine

【Auxiliary inspection】

cerebrospinal fluid

Subarachnoid space obstruction: ① The pressure below the level of obstruction is very low (or even undetectable); ② The neck compression test is abnormal; ③ cerebrospinal fluid protein-cell separation (protein > 10g/L but cells are normal), and the yellow cerebrospinal fluid automatically coagulates after flowing out (Froin's sign)

Abnormal neck compression test: ① Note: When performing lumbar puncture to release cerebrospinal fluid and perform neck compression test below the level of obstruction, it may cause the space-occupying lesion to shift and worsen the compression symptoms.

Videography

Spine X-ray, CT/MRI, myelography

[Diagnosis] ① Determine whether it is spinal cord compression; ② Determine the segment of spinal cord compression; ③ Determine whether it is an intramedullary lesion, extramedullary intradural lesion, or epidural lesion; ④ Determine the nature of the lesion

【Differential Diagnosis】

Section 3 Other spinal cord diseases

1. Syringomyelia: The lesions are mostly located in the lower cervical & upper thoracic spinal cord, and can also involve the medulla oblongata (bulbar syringomyelia); more common in young people; onset is insidious; typical manifestations are segmental dissociative sensory impairment (damage to the central canal) nearby structures and anterior white matter association), muscle atrophy in the area dominated by the diseased segment, and neurotrophic disorders (Morvan's sign ①, Charcot's joint ②); often combined with other congenital malformations; MRI is the preferred method for diagnosis

① Epidermal burns and trauma in areas with analgesia can cause stubborn ulcers and scar formation, and even painless necrosis and falling off of the ends of the digits (toes).

② It is a neurogenic joint (also seen in neurosyphilis); loss of joint pain can cause joint wear, atrophy, deformity, joint swelling, increased mobility, and obvious bone friction during exercise without pain.

2. Subacute combined degeneration of the spinal cord (SCD): It is a degenerative disease of the central and peripheral nervous systems caused by insufficient vitamin B12 intake, absorption, combination, transport or metabolism disorders in the body; the lesions mainly involve the posterior cords of the spinal cord, Lateral cords and peripheral nerves, clinical manifestations include deep sensory loss in both lower limbs, sensory ataxia, spastic paralysis and peripheral neuropathy, often accompanied by anemia and psychiatric symptoms