of spinal cord （090312）脊髓疾病课件

Christorph Reeve , known as the star actor of “Superman”（ 超人） , fell from horse when riding and became tetraplegia （四肢瘫） in 1995， and died in 2007 Similar accident took place when Chinese gymnastics athlete, Sanlan（桑兰） , was exercising in the 4th Goodwill Games in New York on 21st July , 1998. The cervical spine injury led to tetraplegia . Zhanghaidi（张海迪）, she had hemangioma(血管瘤） in T2, broke up in her five years, the bleeding compressed the spinal cord caused paralysis (截瘫) Lou Gehrig(19031941), one of the best baseball player in the world, was such a ALS （肌萎缩侧索硬化）patient.（ Lou Gehrig disease) Stephen Hawking , a genius physicist , is another case of ALS . Chapter 4 Spinal Cord Diseases (脊髓疾病) Purpose ： 1) Comprehend: The general picture of spinal cord diseases ; 2) Acquaint: Clinical manifestation, diagnosis and differential diagnosis, treatment principle of acute myelitis （急性脊髓炎） posterior horn / posterior root lesion Autonomic function disturbance : sphincter dysfunction，lack of sweating, skin ulcer Three types of lesion of spinal cord Selective lesion (Local lesion)Selective lesion (Local lesion) （局灶性损害）（局灶性损害） 2. 2. SemitransverseSemitransverse lesion lesion（半横贯性（半横贯性 损害）损害） (Brown-(Brown-SequardSequard syndrome) syndrome) 3. Complete transverse lesion （完全性横贯性损害）横贯性损害） 1. Selective Lesion1. Selective Lesion (Local Lesion)(Local Lesion) (including six (including six groups)groups) （1 1）Anterior Horn LesionAnterior Horn Lesion Symptom:Symptom: flaccid paralysis(flaccid paralysis(弛缓性麻痹）弛缓性麻痹） (lower motor neuron lesion)(lower motor neuron lesion) DiseasesDiseases : : Acute Acute poliomyelitispoliomyelitis（急性脊髓灰（急性脊髓灰 质炎，也称小儿麻痹症）质炎，也称小儿麻痹症） Progressive spinal Progressive spinal muscular atrophymuscular atrophy （进行性脊肌萎缩症）进行性脊肌萎缩症） （2 2）Pyramidal Tract lesionPyramidal Tract lesion Symptom:Symptom: Spastic paralysisSpastic paralysis (Upper motor neuron lesion) (Upper motor neuron lesion) Disease:Disease: Primary lateral Primary lateral sclerosissclerosis ( (原发性侧索硬化）原发性侧索硬化） （3）Anterior horn+Pyramidal tract Symptom:( cervical enlargement lesion) Flaccid paralysis+spastic paralysis on the hands； spastic paralysis on the legs Disease: Amyotrophic lateral sclerosis (ALS)（肌萎缩性侧索硬化） （4 4）Posterior Column LesionPosterior Column Lesion SymptomSymptom: : Deep sensation disturbanceDeep sensation disturbance Disease:Disease: TabesTabes dorsalisdorsalis （脊髓痨）脊髓痨） (5) Posterior Column+Pyramidal Tract Symptom: deep sensation disturbance + spastic paralysis Disease: Subacute combined degeneration of the spinal cord （脊髓亚急性联合变性） （6 6）Lesion In The Gray MatterLesion In The Gray Matter Symptom: dissociated （分离性）sensory disturbance ，segmental sensory loss， muscles wasting in the hands Nutrition disturbance Disease: Syringomyelia （脊髓空洞症） Spinal hemorrhage （脊髓出血） 2. 2. SemitransverseSemitransverse lesion lesion（半横贯损害）半横贯损害） (Brown-(Brown-SequardSequard syndrome) syndrome) On the side of the On the side of the lesion:lesion: limb(slimb(s) spastic ) spastic paralysis, paralysis, deep deep sansationsansation lost lost On the opposite side On the opposite side of the lesion: of the lesion: superficial superficial sansationsansation lostlost 3. Complete transverse lesion （ 完全性横贯性损害） Acute myelitis, trauma Below the level of the lesion ： Spastic paralysis(痉挛性截瘫) Complete loss of all modalities sensation Sphincter disturbances Lesion localization (病灶定 位） 1.The upper cervical region (C1-4) Pyramidal tract signs (锥体 束征) in four limb-slight damage Tetraplegia(quadriplegia) ( 四肢瘫)-severe damage Pain in the neck and occiput 2. The cervical enlargement(C5-T2) Flaccid hyperactive; pathological pathological reflexes reflexes positive;positive; cremastericcremasteric( (提睾提睾) ) & & abdominal abdominal reflexes reflexes can not be elicited.can not be elicited. Compression Compression of the of the corticospinalcorticospinal tracttract 5. 5. Autonomic symptoms:Autonomic symptoms: The The sphincters sphincters disturbance disturbance later later occuroccur 6. The spine:6. The spine: deformity, tendernessdeformity, tenderness Auxiliary Examination RadiographyRadiography MyelographyMyelography ( (脊髓造影）脊髓造影） CT scan, MRICT scan, MRI CSFCSF Diagnosis and Differential Diagnosis 1. 1. Differentiate from the non-compressive diseases:non-compressive diseases: Acute Acute onset onset : : occurring occurring complete complete or or incomplete incomplete transverse lesionstransverse lesions Chronic Chronic onset onset : : occurring occurring root root pain, pain, Brown-Brown-SequardSequard syndromesyndrome Differential diagnosis:Differential diagnosis: Root pain: Root pain: Pleurisy,(Pleurisy,(胸膜炎）胸膜炎）, angina , angina pectorispectoris（心（心绞绞绞绞痛）痛）, , cholecystitischolecystitis（胆囊炎）（胆囊炎）, etc. , etc. Cord transverse lesion:Cord transverse lesion: multiple sclerosis, multiple sclerosis, syringmyeliasyringmyelia, motor neuron , motor neuron disease, etc.disease, etc. 2.2. Localization Localization of of the the affected affected segmental level:segmental level: root pain, root pain, Segmental Segmental atrophic muscles,atrophic muscles, change change of of reflexes, reflexes, the upper limit of the upper limit of sensory loss.sensory loss. ManifestionExtradural （硬膜外） Extramedull ary(脊髓外) Intramedulla ry（髓内） Root painsocccur earlyearlyless frequent Symptoms develop bilaterall,sym metrical Unilateral to bilateral bilareral, symmetrical Motor symptomsappear firstearlierearlier Sensory changeslateearlyearly Sphincter disturbanceslaterlaterearly Protein content of CSF slight increasedhigh lower 3.3. To determine the location of the lesionTo determine the location of the lesion 4. Diagnosis of the causes of compression According to: mode of onset, symptoms and signs of the cord, Change of CSF, symptoms develop, X-ray, CT, MRI. Treatment 1.1. The The appropriate appropriate treatment treatment of of the the source. source. For For example:example: TuberculousTuberculous spinal spinal osteitisosteitis ( (antituberculousantituberculous therapy therapy + + appropriate appropriate operation), operation), extraduralextradural abscess(early abscess(early operation operation + + adequate adequate antibiotics antibiotics therapy) therapy) , , spinal spinal tumor (operation) .tumor (operation) . 2. Rehabilitation Part Five Vascular Myelopathies 脊髓血管病 Types of vascular myelopathies 1. Infarction of the Spinal Cord 2. Hematomyelia(脊髓出血) 3. Arteriovenous malformation (AVM) （动静 脉畸形） Zhanghaidi, she had hemangioma(血管瘤) in T2, broke up in her five years, the bleeding compressed the spinal cord caused paralysis. Hematomyelia(脊髓出血): An acute painful transverse myelopathy, the central grey matter is much damaged than the white matter. Diagnosis : best made by CT or MRI. Treatment : conservative therapy or operation 血 管 畸 形 并 出 血 （脊髓空洞症） SyringomyeliaSyringomyelia Definition A A cavity cavity expansion expansion of of the the spinal spinal cord cord produces produces a a progressive progressive myelopathymyelopathy. . If If the the cavity cavity extends extends to to the the medullar medullar oblongata oblongata - syringobulbiasyringobulbia ( (延髓空洞症延髓空洞症) ) Etiology 1.Developmental disorders of the posterior fossa(后颅窝颅窝 ） and foramina magnum（枕骨大孔） Congenital malformation of the central canal of the spinal cord Obstruction of the foramina magnum. Pathology Cavity fills with liquor similar to CSF. Cavity expansion first affects the posterior horn anterior hornlateral horn desending and ascending pathways. Manifestations 1.1. Disease Disease occurs occurs in in 2020 30 30 years years old, old, developing developing insidiously.insidiously. 2.2. 2. 2. Classical sympt