Paraplegia Dr. Shamekh M. El-Shamy

Paraplegia Definition: Definition: Paraplegia is paralysis or weakness (paraparesis) of both lower limbs. It may be due to:

Spinal paraplegia may be: Spinal paraplegia may be: 1. Focal 1. Focal 2. Systemic 2. Systemic 3. Disseminated paraplegia 3. Disseminated paraplegia

Causes of Spinal Paraplegia I-Focal Causes : A- Compression: A- Compression:

Neoplastic diseases: Neoplastic diseases:

2- Meningeal (extramedullary): 3- Cord (intramedullary): -

B- Inflammatory: C- Vascular : II- SYSTEMIC CAUSES:

III-DISSEMINATED CAUSES:

CEREBRAL PARAPLEGIA A- Causes in the Parasagittal Region: (area of cortical presentation of L.L.) B- Causes in the brain Stem :

CLINICAL PICTURE OF FOCAL PARAPLEGIA A. AT THE LEVEL OF THE LESION:

a)Posterior root affection: b)Anterior root affection:

B.BELOW THE LEVEL OF THE LESION (cord manifestations): 1- Motor Manifestations:

(paraplegia in extension) (paraplegia in extension) (paraplegia in flexion). (paraplegia in flexion).

2- Sensory Manifestations a) If the cause of the lesion is extramedullary,

b) If the cause of the lesion is intramedullary,

Sensory level below which all sens. are lost Extramedullary copression Jacket sensoryy loss Intramedullary

3- Sphincteric Manifestations a)In acute lesions: b)In gradual lesions:

Investigations 1) C.S.F. Examination. 2)Plain X-Ray of the Spine. 3) Myelography.

Treatment of Paraplegia I- General: - Care of the skin. - Care of the bladder.

II- Physiotherapy

III- Symptomatic Treatment a) Analgesics and sedatives for pain. b) Muscle relaxants : Valium for the spasticity. c)Vitamins and tonics.

IV- Specific Treatment Antituberculous drugs in case of Pott's disease. Antituberculous drugs in case of Pott's disease. Deep X-ray in case of intra-medullary tumour. Deep X-ray in case of intra-medullary tumour. Surgical eradication in case of extra- medullary tumour. Surgical eradication in case of extra- medullary tumour.

Cauda Equina Epiconus Conus Cadua Equina Roots

CAUSES OF CAUDA EQUINA LESIONS 1- Congenital: Spinal bifida. 1- Congenital: Spinal bifida. 2-Traumatic: 2-Traumatic: 3-Inflammatory: Pott's disease of the lumbar vertebrae. 3-Inflammatory: Pott's disease of the lumbar vertebrae. 4- Neoplastic: 4- Neoplastic: 5. Degenerative: Lumbar Spondylosis. 5. Degenerative: Lumbar Spondylosis.

Neurogenic Bladder 1.Sensory atonic bladder 2.Motor atonic bladder 3.Autonomic bladder I U.M.N.L. 1. Acute : Retention with overflow 2. Gradual:a- Partial: Precipitancy b-Complete:Automatic bladder II L.M.N.L.

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