Spastic Paraplegia Neurology Unit presentation

1. Introduction

2. SPINAL CORD DISORDERS
• AETIO-PATHOGENESIS & CLINICAL FEATURES
PRESENTED BY
DR. AGHO E. J
MBBS (AAU)

3. Outline
• Epidemiology
• Classification of spinal cord disorders
• Pathophysiology

4. Epidemiology
• Epidemiology of spinal cord disorders is perculiar to
specific diseases entity, for example Low back Pain of
spinal origin is a common presentation in young
Americans below the age of 45yr.

5. ctn
• Cervical spondylotic changes occur naturally with aging, it
appears radiologically in about 90% of the population
aged 65 or older.
• Cauda equina syndrome acct for 1-2% of patients with
intervertebral disc herniation and occur in 7/100000 per/yr

6. classification
• Compressive Vs Non Compressive
• Acute Vs sub-acute and chronic
• Etiology

7. Classification
Spinal cord disorders
Myelopathy due to degenerative and
Structural spine Diseases
a) Cervical spondylotic myelopathies
b) Thoracic and lumbar spondylosis
c) Syringomyelia
d) Hirayama Disease

8. ctn
 Vascular myelopathies
a. Spinal cord infarction
b. Spinal dural arteriovenous fistula
c. Intramedullary arteriovenous malformation
d. Cavernous angioma
e. Vasculitis
f. Epidural hematomas

9. ctn
Metabolic and Toxic causes of
myelopathy
a. Nutrient deficiency
myelopathies
•Vitamin B12
•Folic acid
•Copper
•Vitamin E

10. ctn
b. Toxic myelopathies
• Nitrous oxide
• Heroin
• Konzo (cassava)
• Neurolathyrism
• Radiation

11.  Myelopathy associated with micro-organisms
a. Viruses
• HIV 1
• Herpes 1&2
• VZV
• EBV
• CMV
• Rubella
• Mump

12. a. Bacteria
• M. tuberculosis
• Treponema pallidum
• Listeria monocytogenes
• Brucella species

13. a. Fungi
• Aspergillus fumigatum
• Cryptococcus neoforma
• Candida species
• Coccidioides immitis
• Blastomyces dermatitidis

14. a. Parasites
• Taenia solium
• Toxoplasma gondii
• Trypanosoma cruzi
• Echinococcus granulosis

16.  Immune-mediated myelopathies
a. Transverse myelitis
• Due to
Multiple sclerosis (MS)
Neuromyelitis optica

17. Mixed connective tissue disorders
Sarcoidosis
Acute demyelinating encephalomyelitis
paraneoplastic

18.  Neoplastic myelopathies
a. Direct involvement of the spinal cord by neoplasm
• Intradural intramedullary (parenchymal)
i. Primary spinal cord tumors
Ependymoma
Astrocytoma
hemagioblastoma

20. ctn

21. ii. Metastatic
• Intradural extramedullary
Peripheral nerve sheath tumor
Meningioma
Schwannoma
neurofibromas
Leptomeningeal metastasis

22. Extradural Extramedullary
• metastasis Breast CA, Lung CA, MM
• hematoma
• TB spine

23. ctn
b. Indirect involvement
Radiation injury
Chemotherapy injury
Paraneoplastic

24. ctn
Disorders of cauda Equina.
Diskogenic Cauda Equina
Compression
Cauda equina syndrome

25. CTN
 Nondiskogenic Cauda Equina
Disorders
Traumatic
Neoplastic

26. Ctn
Infectious
Iatrogenic.
Other structural etiology
a. Dural arteriovenous fistula
b. Dutal ectasia
c. Epidural lipomatosis

27. Pathophysiology
• Cervical spondylotic myelopathy;
• The development of cervical spondylotic myelopathy is
due to a combination of factors which include external
compression from spondylotic canal stenosis,
biomechanical stretch and vascular factors.
• Spondylosis refers to age related degenerative changes
of the spine

28. ctn
• It begins with dessication of the intervertebral discs,
bulging or herniation of the disc material,
• Osteophyte formation along the vertebral endplates, this
combine with the degenerative disc to form osteophytic
bars which impinge on the spinal cord.
• Calcification of the posterior longitudinal ligament may
also compress the cord ventrally, while ligamentum flava
pathology may compromise cord .

31. Clinical features of spinal cord disorders
• Cervical spondylotic myelopathy
 Presents with;
Progressive gait dysfunction
Neck stiffness
Vague sensory changes in lower extremeties
Difficulty performing fine motor functions
Proximal limb weakness

32. ctn
Paraesthesia of the hands, shoulder, subscapular regions
Bladder disturbance; incontinence,retention,
Spastic gait
Increased tone, ankle clonus, hoffman and babinski sign
positive, hyperreflexia
Large fibre sensory loss if posterior column is affected
with reduced stability

33. Anterior horn cell involvement manifest as segmental
lower motor n. finding

34. Location Sign and symptoms
Cervical
spine
Headache or neck, shoulder, or arm pain
Breathing difficulties
Loss of sensation in the arms
Muscle weakness in the neck, trunk, arms, and
hands
Paralysis involving the neck, trunk, arms, and
hands.
Lhermites sign
Thoracic
spine
Pain in the chest and/or back
Loss of sensation below the level of the tumor
Increased sensation above the level of the tumor
Muscle weakness
Paralysis
Positive Babinski reflex
Bladder and bowel problems
Sexual dysfunction
Lumbosacra
l
spine
Low back pain that may radiate down the legs and/or
perineal area
Weakness in the legs and feet
Paralysis in the legs and feet
Loss of sensation in the legs and feet
Bladder and bowel problems
Sexual dysfunction

35. C/F
CONUS MEDULLARIS CAUDA EQUINA
Sudden and bilateral onset Gradual and unilateral
onset
Radicular pain less
prominent
Radicular pain more
prominent
More low back pain Less low back pain
Symmetric, distal,
hyperreflexic
paresis
Asymmetric, areflexic
paraplegia
Symmetric, bilateral,
typically
perianal area sensory loss,
sensory dissociation occurs
Asymmetric, typically
saddle
area, no sensory
dissociation
Early sphincteric signs Late sphincteric signs

37. Management
• Investigations
• Diagnosis
• Treatment.