1、Christorph Reeve,known as the star actor of“Superman”（超人超人）,fell from horse when riding and became tetraplegia（四肢瘫四肢瘫）in 1995，and died in 2007Similar accident took place when Chinese gymnastics athlete,Sanlan（桑兰桑兰）,was exercising in the 4th Goodwill Games in New York on 21st July,1998.The cervical s
2、pine injury led to tetraplegia.Zhanghaidi（张海迪张海迪）,she had hemangioma(血管瘤）血管瘤）in T2,broke up in her five years,the bleeding compressed the spinal cord caused paralysis (截瘫截瘫)Lou Gehrig(19031941),one of the best baseball player in the world,was such a ALS（肌萎缩侧索硬化）（肌萎缩侧索硬化）patient.（Lou Gehrig disease)S
3、tephen Hawking,a genius physicist,is another case of ALS.Chapter 4 Spinal CordDiseases(脊髓疾病脊髓疾病)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）（急性脊髓炎）&spinal cord comp
4、ression（脊髓压迫症）（脊髓压迫症）3)Grasp:three main symptoms&localization(定位定位)of Spinal Cord Diseases Teaching hour：2 lecturing hoursCONTENTS Part 1 Anatomy Part 2 Manifestations Part 3 Lesion Localization Part 4 Acute myelitis Part 5 Compressive myelopathy Part 6 Vascular Myelopathies Part 7 Syringomyelia&ANA
5、TOMY Spinal Cord Anatomy Relevant to Clinical SignsLies within the vertebral canalMedulla oblongataforamen magnum level of the first lumbar vertebraLower endconus medullaris（圆锥）（圆锥）filum terminale（终（终丝）丝）coccyxtwo enlargements:Cervical(C5-T2)Lumbar(L1-S2)Spinal segments do not correspond numerically
6、 with enclosed vertebra.The length of spinal cord:about 2/3 of the vertebras.Pia mater（软脑膜）（软脑膜）:forms the immediate covering of the cordTwo spacesTwo anterior columnTwo posterior columnTwo lateral column All fibersPeripheral white matter:Lateral spinothalamic tract（脊髓丘脑侧束）（脊髓丘脑侧束）:conduct superfici
7、al sensationVentral spinothalamic tract（脊（脊髓丘脑前束）髓丘脑前束）Tracts of Gracilis and Cuneatus（薄束和楔束（薄束和楔束）:conduct deep sensation Three Main Symptoms of spinal cord diseases1.Motor disturbance Upper Motor Neuron Paralysis(Spastic paralysis)（痉挛性瘫）痉挛性瘫）caused by:Pyramidal tract lesion Lower Motor Neuron Para
8、lysis(Flaccid paralysis（弛弛缓性瘫缓性瘫）caused by:anterior horn/ventral root lesion2.Sensation disturbance,caused by:spinothalamic,gracilis and cuneatus tracts lesion;posterior horn/posterior root lesion 3.Autonomic function disturbance:sphincter dysfunction，lack of sweating,skin ulcerThree types of lesion
9、 of spinal cord3.Complete transverse lesion （完全性完全性（3）Anterior horn+Pyramidal tractSymptom:(cervical enlargement lesion)Flaccid paralysis+spastic paralysis on the hands；spastic paralysis on the legsDisease:Amyotrophic lateral sclerosis(ALS)（肌萎缩性侧索硬化）（肌萎缩性侧索硬化）(5)Posterior Column+Pyramidal TractSympt
10、om:deep sensation disturbance+spastic paralysisDisease:Subacute combined degeneration of the spinal cord（脊髓亚急性联合变性）（脊髓亚急性联合变性）Symptom:dissociated（分离性）（分离性）sensory disturbance，segmental sensory loss，muscles wasting in the hands Nutrition disturbance Disease:Syringomyelia（脊髓空洞症）（脊髓空洞症）Spinal hemorrhag
11、e（脊髓出血）（脊髓出血）3.Complete transverse lesion （完（完全性横贯性损害）全性横贯性损害）Acute myelitis,traumaBelow the level of the lesion：Spastic paralysis(痉挛性截瘫痉挛性截瘫)Complete loss of all modalities sensation Sphincter disturbances Lesion localization (病灶定病灶定 位）位）1.The upper cervical region(C1-4)Pyramidal tract signs(锥体锥体束征
12、束征)in four limb-slight damageTetraplegia(quadriplegia)(四肢瘫四肢瘫)-severe damage Pain in the neck and occiput2.The cervical enlargement(C5-T2)Flaccid&spastic paralysis+segmental sensory disturbance in the upper limbsSpastic paralysis in the lower limbsSpastic paralysis in the lower limbs Sensation lost
13、below the level of the lesion4.The lumbar enlargement(L1-S2)in the lower limbs:Flaccid paralysis Segmental sensory disturbance5.The conus medullaris(L3-5)and coccyx:Sensation loss in the perineum（会阴会阴）and buttocks（臀部臀部）in“saddle shaped”（马马鞍型）鞍型）distribution,sphincter disturbance6.The cauda equinaAtr
14、ophic paralysis below the knee,saddle-shaped sensation disturbance,pain in the lower limbs,disturbance of the bladder and bowelACUTE MYELITIS（急性脊髓炎）（急性脊髓炎）DEFINITIONETIOLOGYThe site of Inflammation:edema and hyperemia.The leptomeninges:congested and infiltrated with inflammatory cells.The substance
15、of the cord:congestion,perivascular inflammatory Infiltration.The cells of the grey matter:DegenerationThe white matter:Demyelinated of the myelin sheaths(髓鞘髓鞘)Degeneration of the axis cylinders(轴索轴索)Acute myelitis 急性脊髓炎急性脊髓炎 MRI T1T2MANIFESTATION Auxiliary Examination1.Peripheral blood WBC count el
16、evates slightly in acute stage.2.CSF:Both protein(0.5-1.2g/L)and white cells(20-200)106/L increase slightly sometimes moderately.3.No obstruction found in the vertebral canal.4.CT or MRI reveals the lesion.DIAGNOSISR a p i d o n s e t o f t h e symptoms and signs of a transverse lesion of the spinal
17、 cord.Changes of CSF.MRI abnormal signal.Differential diagnosis胸椎转移瘤（肝脏转移）胸椎转移瘤（肝脏转移）胸胸 椎椎 转转 移移 瘤瘤 Hematomyelia(脊髓出血脊髓出血):An acute painful transverse myelopathy,the central g r e y m a t t e r i s m u c h damaged than the white matter.Diagnosis is best made by CT or MRI.血血 管管 畸畸 形形 并并 出出 血血Treatmen
18、t4.General measures including care of the skin and urinary tract particularly.5.Early institution of physical therapy,such as massage,acupuncture,and other measures-rehabilitation.Antibiotics(抗生素）抗生素）Steriod(激素）激素）Vitamin(维生素）维生素）Diaper(尿布）尿布）+Compressive myelopathy（压迫性脊髓病（压迫性脊髓病）DefinitionA group o
19、f diseases caused by the occupied(占占位性位性)lesions within the vertebral canal,leads to compress the spinal cord,occurring relevant symptoms and signs.EtiologyDisease of the vertebral column：(1)Trauma vertebrafracturewith spinal cord cut off(2)Tuberculous osteitis(3)Tumor of the vertebraEpidura abscess
20、(硬硬 膜膜 外外 脓脓 肿肿)Astrocytoma of the spinal cord(脊脊 髓髓 星星 形形 细细 胞胞 瘤瘤)Schwannoma(神神 经经 鞘鞘 瘤瘤)Lipoma(脂眆瘤脂眆瘤)Gd-DTPAT1WI T1WIMeningioma(脊脊 膜膜 瘤瘤)Effects of compression upon the cordDirect pressure interferes with conduction in the spinal roots and in the cord.Compression of the arteries leads to ischemi
21、a of the segments of the cord.Pressure upon the spinal veins leads to edema of the c o r d b e l o w t h e s i t e o f compression.O b s t r u c t i o n o f t h e subarachnoid space leads to changes of CSFMANIFESTATION Mode of onset:Acute:injury subacute:arachnoiditis chronic:extramedullary tumor2.S
22、ensory symptoms Pains radiating in the distribution of one or more spinal roots,unilateral or bilateral.Paresthesia in the limbs.Compression of spinothalamic tract located in the affected side impairment of appreciation of pain,heat and cold on the opposite side of the body.(Brown-Sequard Syndrome)3
23、.Motor symptomsAuxiliary ExaminationDiagnosis and Differential DiagnosisDifferentiate from the ManifestionExtradural（硬膜外（硬膜外）Extramedullary(脊髓外脊髓外)Intramedullary（髓内）（髓内）Root painsocccur earlyearlyless frequentS y m p t o m s developbilaterall,symmetricalUnilateral to bilateralb i l a r e r a l,symme
24、tricalMotor symptomsappear firstearlierearlierS e n s o r y changeslateearlyearlyS p h i n c t e r disturbanceslaterlaterearlyProtein contentof CSFslight increasedhighlower4.Diagnosis of the causes of compressionAccording to:mode of onset,symptoms and signs of the cord,Change of CSF,symptoms develop
25、,X-ray,CT,MRI.Treatment2.RehabilitationPart FiveVascular Myelopathies 脊髓血管病脊髓血管病Types of vascular myelopathies1.Infarction of the Spinal Cord 2.Hematomyelia(脊髓出血脊髓出血)3.Arteriovenous malformation (AVM)（动静脉畸形）（动静脉畸形）Zhanghaidi,she had hemangioma(血管瘤血管瘤)in T2,broke up in her five years,the bleeding com
26、pressed the spinal cord caused paralysis.Hematomyelia(脊髓出血脊髓出血):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血血 管管 畸畸 形形 并并 出出 血血（脊髓空洞症）（脊髓空洞症）Definition Etiology 1.Dev
27、elopmental disorders of the posterior fossa(后颅窝）后颅窝）and foramina magnum（枕骨大孔）（枕骨大孔）2.Congenital malformation of the central canal of the spinal cord3.Obstruction of the foramina magnum.PathologyCavity fills with liquor similar to CSF.Cavity expansion first affects the posterior horn anterior hornlat
28、eral horn desending and ascending pathways.Manifestations HyporeflexesMuscles wasting in the handsNutrition disturbance:skin ulcers,sweating abnomal Charcots joints(enlargement,deformity without pain)Classical syndromes(continued)Auxiliary examinationDMCT（延迟性（延迟性CT造影）造影）MRIDiagnosis and Differential diagnosis Intramedullary tumor Amyotrophiclateral sclerosis(ALS)（肌萎缩侧索（肌萎缩侧索硬化）硬化）Leprosy(麻风麻风)TreatmentThe drugs for this disease are limitedLarge cavityoperation
