By Ibrahim AlRashidi Abdulrahman AlQarni Jaser AlHarbi Mansour aba Hussain    Supervisor Dr.Mustafa Kandil

By Ibrahim AlRashidi Abdulrahman AlQarni Jaser AlHarbi Mansour aba Hussain Supervisor Dr.Mustafa Kandil PowerPoint PPT Presentation

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By Ibrahim AlRashidi Abdulrahman AlQarni Jaser AlHarbi Mansour aba Hussain Supervisor Dr.Mustafa Kandil

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2. OBJECTIVES Anatomy of ascending and descending tracts of Spinal cord Histology of spinal cord To list the Function of various ascending and descending tracts Terminology Spinal cord injury Management of spinal cord injury

4. Anatomy

5. Spinal Cord Organization Gray matter: mostly cell bodies Dendrites & terminals Spinal reflex integrating center White matter Bundles of myelinated axons Ascending tracts ľ sensory Descending tracts ľ motor Dorsal roots Ventral roots

6. Spinal Cord Organization

7. 18-7 Location of Tracts inside Cord Motor tracts Sensory tracts pyramidal tract (corticospinal) ---spinothalamic tract extrapyramidal tract ---posterior column ---spinocerebellar

8. Ascending Tracts major ascending spinal cord tracts posterior white column spinothalamic lateral and anterior spinocerebellar posterior and anterior

9. Ascending Tracts 1st order Neuron: Dorsal Root Ganglion (Spinal Ganglion) 2nd order Neuron: Spinal Cord 3rd order Neuron: Thalamus PLVNT Termination: Cerebral Cortexöpostcentral gyrusö

12. Descending Tracts Major descending spinal cord tracts corticospinal lateral and anterior Reticulospinal lateral, anterior and medial Rubrospinal

15. Reticulospinal tract

16. Tectospinal tract

17. Rubrospinal tract

24. 1. posterior horn 2. anterior horn 3. intermediate zone (intermediate gray) 4. lateral horn 5. posterior funiculus 6. anterior funiculus 7. lateral funiculus 8. Lissauer's tract 9. anterior median fissure 10. posterior median sulcus 11. anterolateral sulcus 12. posterolateral sulcus 13. Posterior intermediate sulcus

26. Functions of Ascending Tracts : 1- Gracilis and Cuneatus tracts : Discriminative touch Vibratory sense Conscious muscle joint sense (sense of position) 2- lateral spinothalamic tract : Pain Temperature 3- anterior spinothalamic tract : - crude touch -pressure

27. 4- spinotectal tract : Provide afferent information for spinovisual reflexes and brings movements of the eyes and head toward the source of the stimulation . 5- spino-olivary tract : Provides an indirect pathway for further afferent information to reach the cerebellum .

28. Functions of descending Tracts : 1- corticospinal tracts : Rapid ,skilled,voluntary movements.especially distal ends of limbs 2- reticulospinal tracts : Inhibit or faciliate voluntary movement . 3- tectospinal tracts : Reflex postural movements concerning Sight

29. 4- rubrospinal tract : Faciliates activity of extensor muscles and inhibit flexor muscles 5- olivospinal tract : May play a role in muscular activity, But there is doubt that it exists 6- descending autonomic fibers : are concerned with the control of visceral activity - Control sympathetic and parasympathetic systems

30. Terminology Plegia = complete lesion Paresis = some muscle strength is preserved Tetraplegia (or quadriplegia) Injury of the cervical spinal cord Patient can usually still move his arms using the segments above the injury (e.g., in a C7 injury, the patient can still flex his forearms, using the C5 segment) Paraplegia Injury of the thoracic or lumbo-sacral cord, or cauda equina Hemiplegia Paralysis of one half of the body Usually in brain injuries (e.g., stroke)

31. Nerve Tracts of the Spinal Cord

32. Spinal cord injuries

33. Sensory: how do you determine the level?

34. High cervical injuries (C3 and above) Motor and sensory deficits involve the entire arms and legs

35. Midcervical injuries (C3-C5) Varying degrees of diaphragm dysfunction Usually need ventilatory assistance in the acute phase Shock Due to interruption of the sympathetic input from hypothalamus to the cardiovascular centers

36. Low cervical injuries (C6-T1) Usually able to breathe, although occasionally cord swelling can lead to temporary C3-C5 involvement (need mechanical ventilation) The level can be determined by physical exam

37. Thoracic injuries (T2-L1) Paraparesis or paraplegia

38. Cauda equina injuries (L2 or below) Paraparesis or paraplegia

39. What is the central cord syndrome? Usually occurs with a hyperextension of the cervical region Cervical spinal cord involvement with arms more affected than legs May occur with trauma, tumors, infections, etc Traumatic lesions tend to improve in 1-2 weeks Surgical decompression may be indicated if there is spinal stenosis

40. Brown-Sequard syndrome

42. Management Immobilization Rigid collar Sandbags and straps Spine board Log-roll to turn Prevent hypotension Pressors: Dopamine Fluids to replace losses Maintain oxygenation O2 per nasal canula If intubation is needed, do NOT move the neck

44. Gardner-Wells tongs

45. Soft and hard collars

46. Minerva vest and halo-vest

47. Long term care Rehab for maximizing motor function Bladder/bowel training Psychological and social support

48. Questions

49. Resources Neuroanatomy Snell Medical physiology Gyuton Physiology lectures dr.Faisal Histology of SC lecture dr.M.Salah

50. Thank you

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