Lutfi S - PBC9102 Post Bacc Anatomy II Head & Neck - SPINAL CORD.pdf

BRAIN AND NERVOUS SYSTEM XIII SPINAL CORD AND TRACTS DR. KIRAN C. PATEL COLLEGE OF OSTEOPATHIC MEDICINE Nicholas Lutfi, MD, MS, DPM 1. Describe the spinal cord pathways. 2. Identify the ascending and descending tracts. OBJECTIVES 3. Describe the pathology associated with lesions and diseases of the...

BRAIN AND NERVOUS SYSTEM XIII SPINAL CORD AND TRACTS DR. KIRAN C. PATEL COLLEGE OF OSTEOPATHIC MEDICINE Nicholas Lutfi, MD, MS, DPM 1. Describe the spinal cord pathways. 2. Identify the ascending and descending tracts. OBJECTIVES 3. Describe the pathology associated with lesions and diseases of the spinal cord. 4. Identify the arterial supply of the spinal cord. ž LECTURIO AND READING ASSIGNMENTS ž ž ž ž ž ž ž ž ž ž https://www.youtube.com/watch?v=5B87zsAKmWc ž https://www.youtube.com/watch?v=70Kg4uPem4U ž https://www.youtube.com/watch?v=QpoEh9VQ7so ž https://www.youtube.com/watch?v=dZ5H6PesskA SPINAL CORD ž SPINAL CORD ž ž https://nova.lecturio.com/medical-courses/spinal-cord-.lecture SPINAL CORD ž ž ž SPINAL CORD ž ž DORSAL HORN DORSAL ROOT VENTRAL HORN VENTRAL ROOT C L I NI C AL C O MME NT S ž ž SPINAL TAP ž MENINGES OF THE SPINAL CORD SPINAL NERVES SPINAL NERVES ž ž ž ž ž Splnal cord segment c1 - Vertebra ~---' i::::v Atlas(~l) ,·,~ - Axis(C2) ). ;;::.--- f T ~ ;' 1 ! ' 7 " :. - - - - 1, W.oil 1· f~~7=r;--.,--~ -=----lb ---...:....:.-- 1 Fig. 39.22 Segmental Innervation and spinal cord lesions The spinal cord is divided into four major regions: cervical, thoracic, lumbar, and sacral. Spinal cord segments are numbered by the exit points of their associated spinal nerves. (Note: This does not necessarily correlate numerically with the nearest skeletal element.) T12 ~ ---- Ll s Thoracic cord lesion 1 LS Coccyx A Spinal cord segments. B Dermatomes. Each spinal cord segment innervates a particular skin area (dermatome). C Spinal cord lesions. Clinical features of herniated lumbar nucleus pulposus Level of herniation Pain Numbness Weakness Atrophy ~ ·..Ji---' ~ I 5 disc; lumbar ot L5-S1 disc; 1st sacral nerve root Over sacroiliac joint, hip, lateral thigh and leg Over sacroiliac joint, hip, posterolateral thigh and leg to heel ,' Lateral leg, first 3 toes Back of calf, lateral heel, foot to toe Dorsiflexion of great toe and foot; difficulty walking on heels; foot drop may occur Minor Plantar flexion of foot and great toe maybe affected; difficulty walking on toes Gastrocnemius and soleus Reflexes Changes uncommon in knee and ankle jerks, but internal hamstring reflex diminished or absent Ankle jerk diminished or absent BLOOD AND NERVE SUPPLY OF THE SPINAL CORD https://nova.lecturio.com/medical-courses/arterial-supply-of-the-spinal-cord.lecture BLOOD & NERVE SUPPLY OF THE SPINAL CORD ž ž VENOUS DRAINAGE ARTERIAL SUPPLY 1. Vertebral Venous Plexus of Batson ž 2. 3. ž ž 4. ž NERVE SUPPLY 1. ANTERIOR POSTERIOR TRACTS OF THE SPINAL CORD TRACTS OF THE SPINAL CORD ž ž ž 1. 2. 3. SENSORY TRACTS https://nova.lecturio.com/medical-courses/descending-pathways.lecture SENSORY TRACTS ž ž ž ž 1. 2. 3. D O RS AL C O LU MN S Y S TEM MED I AL LEMNI S C U S PATHWAY SENSORY TRACTS – DORSAL COLUMN PATHWAY (MEDIAL LEMNISCUS PATHWAY) ž ž Fasciculus cuneatus = upper body Fasciculus gracilis = lower body TERTIARY NEURON THALAMUS SECONDARY NEURON GRACILIS AND CUNEATE NUCLEI PRIMARY NEURON DORSAL ROOT GANGLION LATERAL SPINOTHALAMIC TRACT LATERAL SPINOTHALAMIC TRACT ž TERTIARY NEURON DORSAL ROOT GANGLION SECONDARY NEURON DORSAL HORN PRIMARY NEURON DORSAL ROOT GANGLION DORSAL SPINOCEREBELLAR TRACT DORSAL SPINOCEREBELLAR TRACT ž ž ž 1. 2. 3. SECONDARY NEURON DORAL HORN PRIMARY NEURON DORAL ROOT GANGLION MOTOR TRACTS MOTOR TRACTS ž ž ž ž L AT E R AL C O R T I C O S PI NAL T R AC T https://nova.lecturio.com/medical-courses/dorsal-column-medial-lemniscal-system.lecture LATERAL CORTICOSPINAL TRACT ž ž ž ž ž PRIMARY NEURON MOTOR CORTEX BRODMANN 4 SECONDARY NEURON VENTRAL HORN SPINAL CORD X1 1. Contralateral hemiparesis/paralysis 2. Contralateral lower facial paralysis X1 X2 X2 1. Contralateral hemiparesis/paralysis 2. CN III, or CN VI, or XII involvement X3 1. Ipsilateral hemiparesis/paralysis X3 LATERAL CORTICOSPINAL TRACT – CLINICAL COMMENTS ž ž REXED LAMINAE OF THE SPINAL CORD https://nova.lecturio.com/medical-courses/rexed-laminae-and-spinal-cord-tracts.lecture REXED LAMINAE OF THE SPINAL CORD ž ž BROWN-SÉQUARD SYNDROME BROWN-SÉQUARD SYNDROME ž proprioception https://nova.lecturio.com/medical-courses/brown-sequard-syndrome-nursing.lecture BROWN-SÉQUARD SYNDROME- ETIOLOGY ž ž ž ž https://nova.lecturio.com/medical-courses/brown-sequard-syndrome-and-tabes-dorsalis.lecture BROWN-SÉQUARD SYNDROME- PATHOPHYSIOLOGY AND CLINICAL PRESENTATION ž 1. upper motor neuron 2. dorsal columns 3. corticospinal tract spinothalamic tract ž 1. UMN 2. fasciculus gracilis fasciculus cuneatus proprioception 3. ž Horner's syndrome IPSILATERAL: 1. Flaccid paralysis at the level of the injury due to injury to the corticospinal tract 2. Spastic paralysis below the level of the injury due to injury to the corticospinal tract 3. Loss of all sensation and fine touch due to injury to the dorsal columns 4. Loss of vibration and proprioception (position sense) due to injury to the dorsal columns CONTRALATERAL: 1. Loss of pain and temperature due to injury to the spinothalamic tract T AB E S D O RS ALIS TABES DORSALIS neurosyphilis ž demyelination root ganglia dorsal spinal cord TABES DORSALIS – SIGNS AND SYMPTOMS weakness diminished ž reflexes paresthesias glossodynia formication hypoesthesias locomotor ataxia loss of coordination urinary incontinence dementia deafness visual impairment Romberg's test Argyll Robertson pupil patellar reflex paroxysmal Westphal's sign P.K. Pel tearing of the eyes to light ž ž gait proprioception sensitivity TABES DORSALIS - ETIOLOGY demyelination tertiary syphilis spirochete bacterium Treponema ž pallidum TABES DORSALIS - TREATMENT ž Intravenously penicillin opiates valproate therapy carbamazepine physical therapy occupational THANK YOU!...