Walking with difficulty

Walking with difficulty

1. Mohammed, 19 years olds

2. Anatomy of the skull

3. Tractology

   • Sensory
     • Dorsal White Column
       • Nucleus gracilis
       • Nucleus cuneatus
     • Ventral & Lateral spinothalamic tract
     • Dorsal & Ventral spinocerebeller tract
   • Motor
     • Lateral corticospinal (pyramidal) tract
     • Anterior corticospinal tract(pyramidal)
     • Vestibulospinal tract
     • Descending autonomic tracts

4. Lesions:

5. Physiology of pain and temperature:

6. Syringomyelia:

   • Clinical presentation:
     • Muscle weakness
       • Evaluation of the patient:
         • 1- History
         • 2- Physical examination
         • 3- Localizing the lesion:
         • 4- Determine the cause of the lesion:
     • Gait abnormalities
       • Hemiplegic gait (spastic gait)
         • Seen in stroke
       • Parkinsonian gait
       • Atexia gait
       • Diplegic Gait(Scissors gait)
         • Seen in cerebral palsy
       • Myopathic Gait (waddling gait)
       • Neuropathic Gait (Steppage Gait)
     • Loss of reflexes
     • Loss of pain, temperature & crude touch sensation
   • Pathophysiology:
     • Congenital
       • Arnold-Chiari malformation II.
     • Acquired
       • Complication of:
         • Trauma
         • Meningitis
         • Hemorrhage
         • Tumor
     • is the development of a fluid-filled cyst (syrinx) within the spinal cord. Over time, the cyst may enlarge, damaging the spinal cord.
   • Treatment
     • If not causing any S&S:
       • monitoring with periodic MRI and neurological exams
     • If causing any S&S yet discovered on MRI for unrelated reason:
       • monitoring with periodic MRI and neurological exams
     • Causing S&S:
       • Surgery:
         • remove the pressure the syrinx places on the SC
         • restore the normal flow of CSF
         • help improve the symptoms and nervous system (neurological) function
     • Treat Chiari Malformation
     • Drain syrnix
     • Removing obstruction
     • Correcting the abnormality

7. Radiological investigation of SC:

   • MRI
     • T1
       • darker; fluid is hypointense (black)
     • T2
       • brighter; fluid is hyperintense (white)

8. Medical report:

   • It should include:
     • Laboratory test results
     • Medical images
     • A history of your treatments
     • Your response to treatments
     • Documentation of any medications
     • Documentation of your diagnosis
     • An overview of your medical history
     • A history of hospitalizations
     • Findings of physical and mental examinations
     • Statements confirming your limitations and abilities

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