PARAPLEGIA

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PARAPLEGIA
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Extradural
Intradural
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INTRAMEDULLARY CORD COMPRESSION

• Glioma
• Syringomyelia
• Tuberculoma
• A-V malformations
• Ependymoma
• Hematomyelia

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EXTRAMEDULLARY
EXTRADURAL
INTRADURAL

• Fracture spine-traumatic
• -pathological Mets, TB .,Osteoporosis
• P.I.D
• Cervical spondylosis
• Spondylolisthesis
• Cranio vertebral anomalies
• Spina bifida
• Meningomyelocoele
• Epidural abscess

• Neurofibroma
• Meningioma
• Malignant metastasis
• Arachnoiditis
• Lipoma, , Fibroma
• Arachnoid cyst

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NON COMPRESSIVE MYELOPATHY

• MULTIPLE SCLEROSIS
• SYRINGOMYELIA
• SUB ACUTE COMBINED DEGENERATION
• ARTERIOVENUS MALFORMATION
• LATHYRISM
• HERIDATORY SPASTIC PARAPLEGIA
• AMYOTROPHIC LATERAL SCLEROSIS
• PRIMARY LATERAL SCLEROSIS
• RADIATION MYELOPATHY
• ADRENOMYELONEUROPATHY
• PROGRESSIVE ENCEPHALOMYELITIS
• PARANEOPLASTIC MYELITIS

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CLINICAL PRESENTATIONS
Extradural Intradural Intramedullary
Onset days / weeks Moderately rapid slow
Root pains Localized , asymmetrical involving 1-2 segments , occ.. bilateral Involving many segments , often bilateral Absent , except in syringomyelia
Fasciculation / -
First symptom Motor involvement , weakness Same Sensory . Crossed spinothalemic tract
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Second symptom Spinothalemic dorsal sensory Same Motor inerveted patern or 2 pattern involvement
Third symptom Late Late to early Early involvement of bladder , later giving rise to automatic bladder
Bowel Late Late to early Firstly constipation followed by incontinence
Reflexes Normal above the level Lost at the level Brisk below Same Same
Spinal tenderness /- Absent
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Spinal deformity Kyphoscoliosis Localised gibbus or stiffness May be present Absent , unless congenital associated abnormalities with disease like syringgomyelia
papilloedema Absent good Absent Present
CSF examination
Manometry Normal , increased Slightly normal
protein Slightly raised Slightly normal
Xanthochromia / - Negative
Spontenious coagulation / - Negative
Queckenstedts test Modified ask him to cough In 1/3 rd patients its absent
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Nerve Supply of Bladder
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Neuronal control of bladder
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Micturition Centers

• The Micturition Control Center in Frontal Lobe
• Inhibitory signals to the detrusor muscle to
  prevent the bladder from emptying (contracting)
• Until a socially acceptable time and place to
  urinate is available.
• Pontine Micturition Center (PMC)
• Coordinates the urethral sphincter relaxation and
• Detrusor contraction to facilitate urination.

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Role of Pontine Center (PMC)

• Stimulation of the PMC causes
• Opening of urethral sphincters
• Contraction of detrusor
• Resulting in bladder emptying
• The PMC is affected by emotions
• Some people micturate when they are excited or
  scared
• The ability of the brain to control the PMC is
  part of the social training
• Usually the brain takes over the control of the
  pons at 3-4 years of age

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Role of Frontal Center

• Stimulation of the Frontal Center causes
• Inhibition of detrusor, until a convenient time
  place is available for micturition.
• By suppressing the Pontine Center (PMC)

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Role of Spinal Cord

• The sacral reflex center is the primitive voiding
  center
• Responsible for bladder contractions

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