Walking with difficulty

Walking with difficulty

1. Tractology

   • Ascending (sensory)
     • Dorsal
       • Gracilus
       • Cuneatus
       • Conscious proprioception
         • Fine touch
           • Vibration
     • Anterior
       • Ventral spinothalamic
         • Pressure and crude touch
     • Lateral
       • Lateral spinothalamic
         • Pain and temperature
   • Descending (motor)
     • Pyramidal
       • Corticospinal
       • Corticonuclear
     • Extra-pyramidal
       • Balance
     • UMNL
       • Hyperreflexia
         • Hypertonia
           • + Babinski
             • No fasciculations
     • LMNL
       • Hypotonia
         • Hyporeflexia
           • - Babinski

2. Skeletal muscles

   • Innervation

3. Reflex

   • It's an involuntary stereotyped response to a stimulus.
   • Components
     • Receptor
       • Sensory nerve
         • Integration center
           • Motor nerve
             • Organ
     • Properties
       • Stimuli
         • Very quick
           • Involuntary
             • Stereotyped

4. Syringomyelia

   • Development of fluid-filled cavity or syrinx within the cervical spinal cord leading to cervical cord enlargement
     • Investigations
       • Physical examination
         • Muscle grading
           • MRI
           • Management
             • Monitoring
               • Follow-up
                 • Surgery
                   • Treating Chiari malformation
                     • Draining the syrinx
                       • Removing the obstruction
                         • Correcting the abnormality
             • Epidemeology
               • 8.4 per 100,000
                 • No race difference
                   • Men > Women
   • Causes
     • Acquired
       • Congenital
         • Chiari malformation
           • Caudal extension of the medulla and cerebellar vermis through foramen magnum
       • Trauma
         • Tumors

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