Download MBBS Paraplegia Lecture PPT

LEVEL OF LESION
Localisation of the lesion is carried out at three levels
?Sensory level
?Motor level
?Reflex level

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SENSORY LEVEL
COMPLETE TRANSECTION OF CORD
All sensory tracts involved ----------total anaesthesia below the level
ANTERIOR SPINAL ARTERY SYNDROME
Spinothlamic tract.................loss of sensations below the level

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SYRINGOMYELIA
Dissociated anesthesia

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DERMATOMES

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MOTOR LEVEL

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AT THE LEVEL OF LESION.................LMN type
BELOW THE LEVEL OF LESION ................UMN type
Hip flexion L1,L2,L3 ankle dorsiflexion L4,L5
Hip extension L5,S1,S2 ankle inversionL5,S1
Hip adduction L2,L3,L4 ankle eversionL5,S1

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Hip abduction L4,L5,S1 plantar flexion L5,S1,S2
Knee extension L2,L3,L4 Big toe extensionL5,S1
Knee flexion L4,L5,S1,S2 extension of other toes and flexionL5,S1

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REFLEX LEVEL

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AT THE LEVEL OF LESION...........reflexes are absent or diminished
BELOW THE LEVEL..................exaggerated

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BLADDER

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VERTEBRAL LEVELS AND
SPINAL SEGMENTS
Vertebral level
Spinal segment
Upper cervical

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same
Lower cervical
+1
Upper thoracic
+2

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Lower thoracic
+3
T 10
L1 ? l2
T11

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L3-l4
T12
L5-S1
L1
S2-C0

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INVESTIGATIONS
BLOOD ROUTINE...........TC,DC,ESR,
MANTOUX TEST
CHEST XRAY
XRAY OF SPINE

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LYMPH NODE BIOPSY
MRI/CT SCAN OF spine
LUMBAR PUNCTURE

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MANAGEMENT
?Adequate nutrition

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?Care of bowel ,bladder and trophic ulcers
?Muscle spasm................. Diazepam
?Underlying cause
?Physiotherapy
?surgery

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