Spinal cord disorders-classification
1. Progressive muscular atrophy PMA
2. Amyotrophic lateral sclerosis (ALS)
3. Progressive bulbar palsy
4. Pseudobulbar palsy
o Spinal muscular atrophy
o Hereditary spastic paraparesis
o Spinocerebellar degeneration
o Friedreich’s ataxia
o Transverse myelitis
o Multiple sclerosis
o Neuromyelitis optica (Devic’s Dx)
o Radiation myelopathy
o TB-meningitis, arachnoditis, granuloma, tuberculoma
o Infarction-ant spinal artery thrombosis
o AV malformation
Konzo - tropical ataxic neuropathy
o AV malformation
Kumar & Clark - Clinical Medicine 8E
A 16-year-old boy suddenly began to walk with both knees in a flexed posture. Initially, his parents
thought he was just joking. However, later that evening he began to experience knife-like pain in
midback radiating around his ribs toward his epigastrium. The next morning, he awakened unable to
get out of bed. He was unable to void.
On neurologic examination he was paraplegic, his muscle stretch reflexes were absent, and his
plantar response “ambiguous.” Sensory exam suggested a T10 level for both pain and temperature
Pertinent laboratory findings included CSF findings with a protein 175 mg/dL, and 30 WBC with 90%
lymphocytes. Nerve conductions demonstrated prolonged F waves but otherwise normal motor and
sensory nerve conductions. The spinal cord had a focal demyelinating lesion with gadolinium
enhancement involving most of its transverse diameter at T9–T11.
Unfortunately a course of intravenous (IV) methylprednisolone was ineffective; he remained
paraplegic, with a persistent dense sensory level and ongoing incontinence.
Spinal Cord Disorders
Spinal Cord Disorders Inflammatory
Epidural, intradural, or intramedullary neoplasm
Posttraumatic compression by # or displaced vertebra or hemorrhage
Antiphospholipid syndrome & other hypercoagulable states
Viral: VZV, HSV-1 & -2, CMV, HIV, HTLV-I, others
Bacterial & mycobacterial: Borrelia, Listeria, syphilis, others
Parasitic: Schistosomiasis, Toxoplasmosis
Tethered cord syndrome
Vitamin B12 ↓ (subacute combined degeneration)
Acute transverse myelopathy (transverse myelitis)
This term is used to describe a cord lesion and paraparesis (or paraplegia) occurring with
Other inflammatory and vascular disorders, e.g. Hiv, sarcoid, syphilis,
Radiation myelopathy &
Anterior spinal artery occlusion.
MRI is usually required to exclude cord compression.
Management of paraplegia
Catheterization is usually necessary initially.
Many patients self-catheterize, or develop reflex bladder emptying, helped by
Free urinary drainage is essential to avoid stasis, subsequent infection and calculi.
2. Bowel. Constipation and impaction must be avoided. (Stool softeners) Following acute
paraplegia, manual evacuation is necessary; reflex emptying develops later.
3. Lower limbs. Passive physiotherapy helps to prevent contractures.
Severe spasticity, with flexor or extensor spasms, may be helped by baclofen,
diazepam, dantrolene, tizanidine or botulinum toxin injections.
1. Skin care.
Risks of pressure sores and their sequelae are serious. Meticulous attention must be
paid to cleanliness and to turning every 2 hours. The sacrum, iliac crests, greater
trochanters, heels and malleoli should be inspected frequently.
Ripple mattresses/water beds are useful.
If pressure sores develop, plastic surgical repair may be required.
Pressure palsies, e.g. of ulnar nerves, must be avoided.
2. DVT prophylaxis/ crepe bandage
3. Prevent orthostatic pneumonia: physiotherapy
Many patients with traumatic paraplegia or tetraplegia return to self-sufficiency.
Specialist advice from a skilled rehabilitation unit is necessary.
Lightweight, specially adapted wheelchairs are available. Patients with paraplegia
have substantial practical, psychological and sexual needs.
General health and morale should be reviewed carefully and regularly.
Any intercurrent infection is potentially dangerous and should be treated early.
Chronic renal failure is a common cause of death. The paraplegic patient needs skilled and prolonged
nursing care and training to be aware of problems.