ParaplegiaParaplegia

Dr. Shamekh M. El-ShamyDr. Shamekh M. El-Shamy

ParaplegiaParaplegia

Definition: Definition: Paraplegia is paralysis or weakness Paraplegia is paralysis or weakness

(paraparesis) (paraparesis) of of both lower limbs. It may both lower limbs. It may be due to:be due to:

Spinal paraplegia may be: Spinal paraplegia may be:

1. Focal 1. Focal 2. Systemic2. Systemic 3. Disseminated 3. Disseminated paraplegiaparaplegia

Causes of Spinal Causes of Spinal ParaplegiaParaplegia

I-Focal Causes :I-Focal Causes : A- Compression:A- Compression:

Neoplastic diseases:Neoplastic diseases:

2- Meningeal (extramedullary):2- Meningeal (extramedullary):

3- Cord (intramedullary):3- Cord (intramedullary):--

B- Inflammatory:B- Inflammatory:

C- Vascular : C- Vascular :

II-II- SYSTEMIC CAUSES:SYSTEMIC CAUSES:

III-DISSEMINATED III-DISSEMINATED CAUSESCAUSES::

CEREBRAL PARAPLEGIACEREBRAL PARAPLEGIA

A- Causes in the Parasagittal RegionA- Causes in the Parasagittal Region: : (area of cortical presentation of L.L.) (area of cortical presentation of L.L.)

B- Causes in the brain Stem :B- Causes in the brain Stem :

CLINICAL PICTURE OF CLINICAL PICTURE OF FOCAL PARAPLEGIAFOCAL PARAPLEGIA

A. AT THE LEVEL OF THE LESION:A. AT THE LEVEL OF THE LESION:

a)Posterior root affection:a)Posterior root affection:

b)Anterior root affection:b)Anterior root affection:

B.B.BELOW THE LEVEL OF THE BELOW THE LEVEL OF THE LESION (cord manifestations)LESION (cord manifestations)::

1- Motor Manifestations:1- Motor Manifestations:

(paraplegia in extension)(paraplegia in extension)

(paraplegia in flexion)(paraplegia in flexion)..

2- Sensory Manifestations2- Sensory Manifestations

a) If the cause of the lesion is extramedullary,a) If the cause of the lesion is extramedullary,

b) If the cause of the lesion is intramedullary, b) If the cause of the lesion is intramedullary,

Sensory level below which all sens. are lostExtramedullary

copression

Jacket sensoryy lossIntramedullary

3- Sphincteric Manifestations3- Sphincteric Manifestations

a)a)In acute lesions:In acute lesions:

b)In gradual lesions:b)In gradual lesions:

InvestigationsInvestigations

1) C.S.F. Examination.1) C.S.F. Examination.

2)Plain X-Ray of the Spine.2)Plain X-Ray of the Spine.

3) Myelography.3) Myelography.

Treatment of ParaplegiaTreatment of Paraplegia

I- General:I- General:

- Care of the skin.- Care of the skin.

- Care of the bladder.- Care of the bladder.

II- PhysiotherapyII- Physiotherapy

III- Symptomatic TreatmentIII- Symptomatic Treatment

a) Analgesics and sedatives for pain.a) Analgesics and sedatives for pain.

b) Muscle relaxants : Valium for the b) Muscle relaxants : Valium for the spasticityspasticity..

c)Vitamins and tonics.c)Vitamins and tonics.

IV- Specific TreatmentIV- Specific Treatment

Antituberculous drugs in case of Pott's Antituberculous drugs in case of Pott's disease. disease.

Deep X-ray in case of intra-medullary Deep X-ray in case of intra-medullary tumour. tumour.

Surgical eradication in case of extra-Surgical eradication in case of extra-medullary tumour.medullary tumour.

Cauda EquinaCauda Equina

Epiconus

Conus

Cadua Equina

Roots

CAUSES OF CAUDA EQUINA CAUSES OF CAUDA EQUINA LESIONSLESIONS

1- Congenital: Spinal bifida.1- Congenital: Spinal bifida.

2-Traumatic:2-Traumatic:

3-Inflammatory: Pott's disease of the 3-Inflammatory: Pott's disease of the lumbar vertebrae.lumbar vertebrae.

4- Neoplastic:4- Neoplastic:

5. Degenerative: Lumbar Spondylosis.5. Degenerative: Lumbar Spondylosis.

Neurogenic BladderNeurogenic Bladder

1.Sensory atonic bladder2.Motor atonic bladder

3.Autonomic bladder

I U.M.N.L.

1. Acute : Retention with

overflow

2. Gradual:a- Partial: Precipitancyb-Complete:Automatic bladder

II L.M.N.L.

Thank you