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1. Localization of spinal cord
lesion

3. Anatomy of spinal cord
Functions of spinal cord
• Sensory
• Motor
• Autonomic functions

4. Sensory conduction
Ascending/ sensory tracts in spinal cord are
A. Tracts in dorsal/posterior white column
B. Tracts in lateral white column
C. Tracts in ventral white column

5. Dorsal column pathway
Includes
• Fasciculus gracilis
• Fasciculus cuneatus
Sensations in it are (fine
touch, pressure, tactile localization, tactile
discrimination, vibration sensation, stereo
gnosis)

6. Tracts in lateral white column
1. Lateral spinothalamic tract(SGR)
2. Ventral spinocerebellar tract
3. Dorsal spinocerebellar tract
Pain and temperature in SGR
itching tickling and sexual sensations are
carried by the spino thalamic pathway

7. Ventral column tracts
• Ventral/anterior spinothalamic tract (chief
sensory nucleus)
• Crude touch

10. Spinal cord syndromes
• Complete transverse cord lesions
• Hemi section of spinal cord
• Central spinal cord lesion
• Posterior column syndrome
• Anterior spinal syndrome
+
Disseminated/ multiple sclerosis
Sub acute combined degeneration of spinal
cord

12. Complete transverse cord lesion
• Features
• Loss of al forms of sensations below the
segmental level of lesion
• Narrow band of hyperesthesia or
paresthesia at the upper margin of level of
sensory loss
• Radicular pain or segmental paresthesia
may occur at the level of lesion

13. Continue…
• In cervical lesion the pain radiate to
arm, in thoracic lesion the pain is
circumferential to chest or abdomen and in
lumbar and sacral lesions pain radiate to
legs

14. causes
• Infection
• Trauma
• Compression by tumour
• Cervical spondylosis
• Transverse myelitis
• Multiple sclerosis

16. hemisection- brown
sequard syndrome
• Features
• Loss of pain and temperature on the
opposite side and the upper margin is
usually 2 or 3 segments below the level of
lesion
• Loss of propriceptive sensation and motor
deficit occur on the same side of lesion
• Touch is not affected because it passes
through the lateral column and dorsal
column of both sided of the cord

17. causes
• Infection
• Trauma
• Compression by tumour
• Cervical spondylosis
• Transverse myelitis
• Multiple sclerosis

18. Central spinal cord lesions
(syringomyelic lesion)
• Features
• Dissociated sensory loss or suspended
sensory loss is loss of pain and
temperature at the level of lesion where
the spinothalamic fibers cross in the cord.
There is loss of pain and temperature on
one or both sides over a number of
dermatomes with normal sensation above
and below and this is called suspended
sensory loss because is has upper and
lower level.

19. Continue…
• Touch is preserved
• There is sacral sparing in intramedullary
lesion

20. causes
• Syringomyelia
• Trauma leading to hematomyelia

21. Posterior column syndrome (tabetic
syndrome)
• Features
• Common complaints are paraesthesias in
the form of tingling pins and needles,
girdle and band like sensation
• Unpleasant tight feeling over limb
• Loss of position and vibration sense below
the level of lesion
• Pain touch and temperature is preserved

22. Continue….
• Sensory ataxia
• Positive romberg’s sign
• Lightening pain occur which is penetrating
occurring at right angle to skin
• Lhermitte’s sign – electric shock like
sensation from the neck travelling down
along spine when the neck is suddenly
flexed or extended this occurs in lesion of
posterior column of cervical region

23. causes
• Neurosyphilis
• DM
• Sub acute combined degeneration
• Friedreich’s ataxia
• Carcinoma
• Multiple sclerosis
• Mercury poisoning

24. Anterior spinal syndrome
• Features
• Loss of pain and temperature below the
level of lesion
• Preserved joint and vibration sense

25. causes
• Anterior spinal artery emboli
• Thrombosis

26. Disseminated/ multiple sclerosis
-means widespread increase of connective
tissue in the nervous system
FEATURES
– widespread demyelinating disease of CNS
- Nerve cells replaced by neuroglial cells
- Delayed or blocked conduction

27. Sub acute combined degeneration
of spinal cord
• Demyelination of white fibers of spinal
cord
• Dorsal and lateral columns are affected
• Seen in pernicious anemia patients

28. Complications of spinal cord
transection
• Patients develop negative nitrogen
balance and catabolize large amounts of
body proteins is due to immobilization
1. Decubitus (postural ulcers) develop.
2. Hypercalcemia/hypercalciurea and
calcium stones in urinary tracts.
3. Urinary stasis with paralysis of bladder.

29. • Therefore the prognosis in patients with
transected spinal cord used to be very
poor and death from septicemia uremia or
inanition, coma and finally death.

30. treatment
• Faster recovery and minimal loss of
function after spinal cord injury is acquired
by administration of large doses of
glucocorticoids
• As early as possible after injury
• Administration of neurotropins
• Implantation of embryonal stem cells at
the site of injury

31. • Another possibility being explored is
bypassing the site of cord injury with brain
computer interfaces devices.
• However these approaches are still a long
way from routine clinical use.

33. Thank u