localizaiton of level of lesion in paraplegia
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TRANSCRIPT
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LOCALISATION OF THE LEVEL OF LESION IN A
COMPRESSIVE MYELOPATHY
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SPINAL CORD
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31 segments
Embryological developmentgrowth of cord lags behind mature spinal cord ends at L1
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Upper quadriplegia + weakness of diaphragm
C4-C5 Quadriplegia
C5-C6 Biceps
Cervical cord
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C7 extensors
C8 flexion
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Nipples T4 Umbilicus T10
SENSORY LEVEL
Disturbance of bladder & bowel habits
Thoracic cord
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L2-L4 Paralysis of flexion & adduction of thigh + weakening of leg extension at knee+ patellar reflex lost
L5-S1 Mvmnts of foot & ankle + flexion & knee + extension of thigh + ankle jerk LOST
Lumbar cord
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B/L saddle anaesthesia [S3-S5]
Bladder & Bowel dysfunction
Impotence
Bulbocavernosus & anal reflexes absent
Muscle strength preserved
Conus medullaris
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Low back& radicular pain
Asymmetrical leg weakness , sensory loss,areflexia in lower extremities
Sparing of bowel & bladder function
Cauda equina
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1) Distribution of root pain
ask for specific dermatomes involved
due to the involvement of posterior nerve roots
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2) Upper border of sensory loss
examine the patient from below upwards for demonstration of upper border of sensory loss
Due to the affection of spinothalamic tract
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3) Girdle like sensation / sense of constriction at the level of lesion
due to the involvement of posterior column
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4) Zone of hyperaesthesia/ hyperalgesia
localise the level of lesion one segment below
Due to compression of posterior nerve roots
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5) Analysis of abdominal reflex
[ upper abdominal reflex (T7-T9) intact - loss of middle (T9-T11) & lower (T11-T12) ones - site of lesion is probably at T10 spinal segment ]
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6) Atrophy of the muscles in a segmental distribution
Due to involvement of anterior horn cells
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7) Loss of deep reflexes if the particular segment is innvolved
brisk below the involved segment
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8) Analysis of BEEVOR’S SIGN
when the patient attempts to lift his head up from the pillow, against resistance
Rectus abdominis
useful in deciding the level of thoracic spoinal cord lesions
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9) Deformity / any swelling in the vertebra
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10) Tenderness in the verterbra
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11) Area of sweating
Lack of sweating below the level
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12) level can also be localised by X-Ray of the spine, Myelography, CT Scan / MRI
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DETERMINATION OF SPINAL SEGMENTS IN RELATION TO VERTEBRA…
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Cervical vertebra
add 1
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T1 - T6
Add 2
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T7 – T9
Add 3
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T 10
overlies L 1 & L 2 segments
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T 11
overlies L 3 & L4 Segments
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T 12
Arch overlies L 5 segment
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L I arch overlies sacral & coccygeal segments
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In the case of non-compressive myelopathy , the question of localisation of the level of lesion does not arise
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Synopsis Of Bladder Dysfunction In Neurological Diseases NEUROGENIC BLADDER
UB receives nerve supply from sympathetic- L 1,2,3 [ NERVE OF FILLING ] & Parasympathetic- S 2,3,4 [NERVE OF EVACUATION]
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SPINAL BLADDER
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A) Incomplete lesion
Precipitancy involvement of inhibitory fibres [multiple sclerosis]
Hesitancy facilitatory fibres involved [incomplete cord compression]
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B) Complete lesion
1-Retention of urine wt overflow incontinence
commonly seen in ‘neural shock stage’ of a/c transverse myelitis
evacuation of bladder is usually
incomplete
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2-Automatic Bladder
evacuation complete
commonly seen when the neuronal shock stage is over& evacuation occurs by local reflex arc
frequency, urgency &urge incontinence
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C) Lesion in the local reflex arc
1- sensory paralytic bladder
loss of awareness of fullness of bladder large volume of urine collects in the
bladder wt huge residual volume
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2- motor paralytic bladder
inability to initiate & continue micturition
seen in trauma, pelvic neoplasm
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3- Autonomous bladder-
common in cauda equina lesions, pelvic malignancy, spina bifida
no sensation of bladder fullness, bt
having continuous dribbling
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THANK YOU…..