神经病学精品教学：Disease of the Spinal Cord.pptVIP

Disease of the Spinal Cord Lu Qinchi,MD,PhD Dept. of Neurology, Ren Ji Hospital Shanghai Jiaotong University School of Medicine Tel: email: qinchilu2005@ Introduction Structure from outside 31 pairs of spinal nerves ( Cervical, Thoracic, Lumbar,Sacral, Coccygeal ) C1-8, T1-12, L1-5, S1-5, Co1 31 Segments of related spinal cord Spinal nerves vs Segment of spinal cord Cervical enlargement C5-T2, Lumbar enlargment L1-S2, Conus medullaris, Cauda equina 3 connected tissue layer Introduction Structure from inside H type gray matter Columns Laminas White matter Columns: fasciculus gracilis, fasciculus cuneatus Tracts: e.g. corticospinal tract Introduction Blood supply of the spinal cord Ant. Spinal artery Post. Spinal artery Introduction Clinical feature of spinal lesion Motor( upper lower motor neuron) Sensory( sensory level) Autonomic dysfunction ( bladder bowel) Clinical Localization of the spinal lesion Brown-Sequard syndrome Transversive myelopathy Spinal Shock Introduction Segmental damage of the spinal cord C1-4: ULE UMNL (quadriplegia) C5-T2:UE LMNL, LE UMNL T3-12: LE UMNL ( paraplegia) L1-S2: LE LMNL S3-5:No paralysis, no pyramidal sign Co: Similar to above Causes of Spinal Cord Disease Trauma Cord compression Vascular cord lesions Transverse Myelitis (MS, Viral infection, SLE, Syphilis) Metabolic and Toxic Cord disease( SCD) Intrinsic Cord Lesions ( Tumor, Syrinx) Myelitis Classification of Inflammatory Disease of the Spinal Cord I. Viral Myelitis II. Myelitis secondary to bacterial, fugal, parasitic,etc III. Myelitis ( Myelopathy) of non infectious inflammatory type Postinfectious and postvaccinal Acute and chronic relapsing multiple sclerosis Myelopathy with Lupus angitis Etiology Pathology ● The locus of a limited number of infective and noninfective inflammatory processes, some causing selective destruction of neurons, others involving the meninges and white matter or leading to a ne