Developing an olfactory cell therapy for spinal cord injury

Different injuries and their effects on the spinal cord

a) Syndromes related to the spinal cord

b) Dermatome and level of injury

i) Sensory loss

ii) Motor paralysis

iii) Autonomic dysreflexia

a) Syndromes Related to the spinal cord

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Spinal Cord Syndromes

•Spinal cord syndromes are a group of signs and symptoms that accompany spinal cord injury.

•Their severity depends on the extent of injury. The spinal cord syndromes are as follows:

     •Complete cord transection

     •Brown-Sequard syndrome

     •Anterior cord syndrome

     •Posterior cord syndrome

     •Central cord syndrome

     •Conus medularis syndrome

     •Cauda equina syndrome

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Complete Cord Syndrome

•Seen in case of a complete spinal cord injury.

•The entire thickness of the spinal cord is involved. 

•There is a complete loss of sensations and motor activity below the level of injury.

•This may prove fatal if the injury is above C4 level.

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Brown-Sequard Syndrome

•This syndrome is seen when exactly half of the spinal cord is injured either on the right or the left side. (Hemi-section of the cord)

•The injured side of the body suffers from paralysis below the injury level but most sensations remain intact.

•However, on the opposite side, the person experiences loss of pain, touch, temperature and pressure sensations below the injury level.

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Anterior Cord Syndrome

•The anterior part of the spinal cord is damaged. 

•This leads to loss (or reduction) of movement, and touch, pain, and temperature sensations below the level of injury. 

•This syndrome can be seen in injuries caused by excessive flexion of the
vertebral column.

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Posterior Cord Syndrome

•There is damage to the posterior part of the spinal cord. 

•Most cases of posterior cord syndrome present with poor coordination.

•Muscle power, and pain and temperature are preserved.

•Seen in neurosyphilis.

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Central Cord Syndrome

•There is damage to the central part of the spinal cord.

•The damage spreads outwards from the center of the cord. Usually, patients complain of upper limb weakness but lower limb function is more or less intact.

•Rarely seen in case of a trauma

•Rather seen in spinal cord diseases and tumors

Conus Medularis And Cauda Equina Syndrome

•Conus medularis contains sacral spinal segments

•There may be bowel, bladder and sexual dysfunction. 

•Motor function around the ankle joint and sensation near the anal region are affected.


•Cauda equina syndrome results in injury to spinal nerves only.

•There may be complete or partial loss of movement and sensation in the lower limbs or the perineal region.

•There may be bowel, bladder and sexual dysfunction.

B) Dermatome and level of injury

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i) Sensory loss

Level of Injury

  

•The spinal (or neurological) level of injury is what determines the extent of the loss of function after spinal cord injury.

•To determine the level of injury, these things are looked at:

•Sensory loss

•Motor loss

•The assessments are done on both sides of the body. The level of injury on the right side may be different from on the left side. [Brown-Sequard syndrome in module 7(a)]

Sensory Loss 


•This is determined by assessing which dermatomes have intact feelings and
which dermatomes lack some or all feelings.

Module 4C has explanation of dermatomes.

•The figure to the left has an approximate depictions of all the dermatomes with their spinal levels.

ii) Motor Paralysis

•Different spinal nerve roots are associated with specific motor activities which can be used to determine motor loss.


•C5 = Elbow flexion

•C6 = Wrist extension

•C7 = Elbow extension

•C8 = Finger flexion

•T1 = Finger extension

  

•L2 = Hip flexion

•L3 = Knee extension

•L4 = Ankle dorsiflexion

•L5 = Long toe extension

•S1 = Ankle plantar flexion

iii) Autonomic Dysreflexia

•In case of an injury level of T6 or above, a form of autonomic dysfunction may occur known as autonomic dysreflexia. 

•There may be a number of symptoms:

     •Severe and sudden hypertension with throbbing headaches

     •Excessive sweating

     •Flushing of the skin

     •Dangerously slow heart rate

     •Apprehension, anxiety, and sometimes cognitive impairment 

•In many cases, it may prove to be lethal if proper medical care and treatment are not given.