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PHYSIOLOGY OF SPINAL CORD
DERMATOMES
SPINAL CORD REFLEXES
TYPES OFREFLEXES SOMATIC VEGETATIVE
STRETCHING FLEXION EXTENTION RHYTMIC MOVEMENTS VASO- URINA- DEFAЕ- OTHERS MOTOR TION CATION
TENDON REFLEXES: WALKING SCRATCHING АХИЛЛОВ, КОЛЕННЫЙ, с m. BICEPS с m. TRICEPS
EFFECT MUSCLE PROTECTIVE STANDING WALKING REMOVAL EFFECTIVE ELIMINATION OF TONES REACTION POSTURE OF EXCITA- BLOOD TOXIC FORMATION TORY STIMULI SUBSTANCES
DESCENDING TRACTS
ASCENDING TRACTS
Tracts of tactile & proprio- sensitivity
Direct tracts (don’t cross)Fasciculus gracilus & fasciculus cuneatus
(tr.bulbo-thalamo-corticalis)Tr. Spino-cerebellaris ventralis (Flexig)
Crossed tractsTr. Spino-thalamo-corticalis anteriorTr. Spino-cerebellaris dorsalis (Govers)
SPINAL CORD REFLEXES
TYPES OFREFLEXES SOMATIC VEGETATIVE
STRETCHING FLEXION EXTENTION RHYTMIC MOVEMENTS VASO- URINA- DEFAЕ- OTHERS MOTOR TION CATION
TENDON REFLEXES: WALKING SCRATCHING АХИЛЛОВ, КОЛЕННЫЙ, с m. BICEPS с m. TRICEPS
EFFECT MUSCLE PROTECTIVE STANDING WALKING REMOVAL EFFECTIVE ELIMINATION OF TONES REACTION POSTURE OF EXCITA- BLOOD TOXIC FORMATION TORY STIMULI SUBSTANCES
STRETCH REFLEX
Antigravitational- helps to maintain erect posture regardless of the influence of the force of gravityReceptors – muscle spindelsNo contact neurons, monosynaptic reflex arch, short reflex timeTendon reflexes are clinical variant of stretch reflex
KNEE-JERK REFLEX
AHILLES REFLEX
SPINAL SHOCKDecreased excitability of spinal cord nervous centers below the level of trauma due to the absence of impulses from higher nervous centers
SPINAL SHOCK MANIFESTATIONS
Absence of spinal cord proper reflexesLoss of sensitivity (astesia)Decrease of muscle tone (atonia)Inability to perform voluntarily movements
RULES OF TOPICAL DIAGNOSTICS :
1. Physician has to take into consideration all the patient’s feelings (sensations).2. Each question asked by physician should get diagnostically valuable answer.3. There should be a certain scheme of questions given to the patient.4. Each question should be targeted at a certain anatomical structure.5. If you don’t know what you are looking for don’t approach the patient!!!
PRINCIPLES OF TOPICAL DIAGNOSTICS OF SPINAL CORD DISEASES
Spinal cord
Patient’s complains Symptoms found at examination
Posterior horn •Pain in segment projection on the side of lesion•Paresthesias•Disturbed sensitivity
•Disturbed sensitivity •Perverted sensations•Decrease in tendon & periostal reflexes
Anterior horn •Decreased volume of movements in a certain segment on the side of lesion•Decreased muscle power in a certain segment•Sensation of smth creeping under the skin•Loss of muscle weight
•Muscle atrophy•Fibrillar contractions•Decreased muscle tone•Decrease in tendon & periostal reflexes or absence of reflexes
Spinal cord
Patient’s complains Symptoms found at examination
Grey commi-ssurae
Bilateral sensations:Pain in the segment
projection ParaesthesiasDisturbed sensitivityUrination disorders
Dissociated sensory loss of coat, pants, gloves, socks type(decreased pain & temperature sensations, preserved tactile)
Decrease or absence of reflexes in certain segments
Trophics disorders (scars after burns)
Spinal cord
Patient’s complains Symptoms found at examination
Lateral funiculus
•Decreased volume of movement on the side of lesion below the level of lesion•Decreased muscle power on the side of lesion below the level of lesion•Tetanic contractions below the level of lesion•Disturbed sensitivity on the opposite side (cold feet, feeling of heat, paraesthesias)
•Increased muscle tone•Increased reflexes•Pathological reflexes•Ascending type of sensitivity disturbances: pain & temperature on the opposite side
Anterior funiculus
Same as at pyramidal tract lesions
Same as at pyramidal tract lesions
Spinal cord
Patient’s complains Symptoms found at examination
Posterior funiculi
Positive Romberg symptomDisturbed finger-nose & heel-
knee probesDisturbances in
proprioreceptionDisturbances of vibration
sensationsIncreased reflexesInability to recognize objects by
touchComplex types sensitivity
disturbances (discrimination in dimerical space sensations, sensation of weight, pressure, kinesthesia)
Positive Romberg symptomDisturbed finger-nose & heel-
knee probesDisturbances in
proprioreception чувстваDisturbances of vibration
sensationsIncreased reflexesInability to recognize objects by
touchComplex types sensitivity
disturbances (discrimination in dimerical space sensations, sensation of weight, pressure, kinesthesia)