7 SPINAL CORD COMPRESSION It may be acute with trauma,metastasis orArterial occlusion or it may be slow developing over weeks as in Pott’s disease,cervical spondylosis etc.
8 POTT’S DISEASETB of spine often involves two or more adjacent vertebral bodies. Lower thoracic and upper lumber vertebrae are commonly involved.Intervertebral disc is also destroyed. With advanced disease paravertebral cold abscess , gibbus formation and PARAPLEGIA occur.
9 TRANSVERSE MYELITISIt is an acute or subacute inflammation of spinal cord occuring after infection or recent vaccination. Many agents like influenza,measles,CMV,EBV and mycoplasma have been implicated.
10 Guillain Barre Syndrome Acute inflammatory or post-infective demyelinating polyneuropathy.Develops 1-3 weeks after respiratoryinfection or diarrhea in >70% cases.Ascending polyneuropathy.
11 MOTOR NEURON DISEASEProgressive degenerative disorder of upper and lower motor neurons in spinal cord,cranial motor neurons and pyramidal neurons in motor cortex.Cause- unknown.PatternsProgressive bulbar palsyProgressive muscular atrophyAmytrophic lateral sclerosis.
12 SUBACUTE COMBINED DEGENERATION OF SPINAL CORD Syndrome of combined spinal cord and peripheral nerve damagecause: Vit.B12 deficinencyChanges start in posterior columnn (affecting vibration and position sense) then involve lateral column(pyramidal tracts)
13 MYASTHENIA GRAVIS Acquired autoimmune disorder of NMJ. Causes skeletal muscle fatigubility and weakness, esp of proximal limb muscles,ocular anb bulbar muscles.
14 DUCHENNE’S MUSCULAR DYSTROPHY X-linked recessive disorderDeficiency of protein dystrophin in muscles.Symptoms start in childhood,become severe in adolescence and death occurs by age 20 years.
15 MANAGEMENT OF PARAPLEGIA HISTORYEXAMINATIONINVESTIGATIONSTREATMENT
16 HISTORYAGE AND SEXYoung age: Inherited disorders,muscle dis.,infectionsOld age: malignancies r common.DURATIONACUTE:GBS,transverse myelitis, cord compression.CHRONIC:MND,polyneuropathies,muscle dis.SPHINCTER DISTURBANCES (INITIALLY URGENCY OR HESITENCY OF MICTURATION,THEN URINARY RETENTION)Seen in UMN lesions.
17 HISTORY SENSORY SYMPTOMS ROOT PAIN In cord compression. BACKACHE Numbness,tingling and hyperesthesias in neuropathy.ROOT PAINIn cord compression.BACKACHEIn cord compression,transverse myelitis.HEADACHE,VOMITINGIntracranial lesionsPRECEDING FEVER,URTIIn GBS
18 EXAMINATION MOTOR SYSTEM FEATURES UMNL LMNL Muscle waisting absent presentMuscle tonePowerDeep reflexes+++_Superficial reflexPlantersFasciculations
19 SENSORY SYSTEMSharp sensory level in transverse myelitis differentiates it from GBS. Neuropathy:glove and stocking distribution.Romberg sign +ve if posterior column is involved.
20 SIGNS OF SPINAL CORD COMPRESSION CERVICAL,ABOVE C5UMN signs and sensory loss in all 4 limbsCERVICAL,C5 TO T1LMNsigns and segmental sensory loss in arms,and UMN signs in legsTHORACIC CORDSpastic paraplegia with a sensory level on trunk.CONUS MEDULLARISSensory loss in sacral area and extensor plantar responseCAUDA EQUINALMN signs in lower limbs.
21 EXAMINATION EXAMINATION OF SPINE For deformity and tenderness. SPHINCTERS:Look for incontinence or retention of urine or faeces.OTHER FEATURES:Anemia-B12 deficiencyStiff neck in cervical spondylosisSite of malignancy.
22 INVESTIGATIONS X-RAY SPINE: May show collapse or erosion of vertebrae,herniated interverteberal disc,mets.,# or dislocation of vertebra etc.MRI:Investigation of choiceCT SCANBLOOD CP:Megaloblastic anemia in subacute combined degeneration of spinal cord.ESR is raised in inflammatory cases.CSF
23 INVESTIGATIONS CSF examination: Inflammatory lesions, both cells and proteins are increased.In malignancy,malignant cells may be present.In transverse myelitis ,proteins are increased and upto 50 lymphocytes/cmm are present.In MS,monoclonal IgG is increased.In GBS,protein cell dissociation is seen.
24 INVESTIGATIONS MYELOGRAPHY: Site of cord compression is demonstrated. NERVE CONDUCTION STUDIES:Helpful in diagnosis of neuropathies.FUNDOSCOPY:For papilloedema due to intracranial tumor or MS.BONE SCAN:Mets and inflammatory vertebral lesions r detected.
25 TREATMENT GENERAL MEASURES SKIN CARE: Change posture every 2-4 hrly to avoid bed sores.Keep skin dry and clean.BLADDER CARE:CATHETERIZATION for urinary retention.BOWEL CARE:Avoid constipation by suitable diet and laxatives.
26 TREATMENT PREVENTION OF CONTRACTURES By regular passive movements. REHABILITATIONBy using wheel chair,standing frames,vocational training etc.
27 SPECIFIC TREATMENT POTT’S DISEASE Immobilization ATT Surgery:Anterior transthoracic decompression.TRANSVERSE MYELITISGlucocorticiods are given.Initially I/V methylprednisolone,then oral prednisolone.
28 TREATMENTMNDSymptomatic T/M like physiotherapy,walking aids,splints and speech therapy.Glutamate antagonist,RILUZOLE ?SUBACUTE COMBINED SPINALCORD DEGENERATIONInjection vit.B ug I/M daily for 7-10 days,then weekly for a month and then monthly for whole life.
29 TREATMENT GBS Plasma pharesis(effective only in first 2 weeks) i/v immunoglobulins(2g/kg in 5 days)No role of steriods.SPINAL CORD TUMORSRadiotherapySurgical decompression.
30 COMPLICATIONS BEDSORES BOWEL AND BLADDER INCONTINENCE DVT PULMONARY EMBOLISMPSYCHIATRIC LAYOUTHYPOSTATIC PNEUMONIADISEASE RELATED COMLICATIONS