Overview
脊髓横贯性损害 Transverse lesions
腰膨大（ L1－S2 ）
Sense
loss of lower limbs and perineum Flaccid paralysis of lower limbs Urinary and fecal retention Autonomic dysfunction Root pain in groin
Acute myelitis
病因 Etiology ：
Infection
分类 Classification：
postinfectious
and vaccination Virus Parasite Bacteria Fungus Unclear
myelitis Postvaccinal myelitis Demyelinating myelitis Paraneoplastic myelitis
前角 Anterior horn: αand γmotor neuron 后角 Posterior horn: secondary sensory
neuron
侧角 Lateral horn:
C8－L2 交感神经低级中枢 Sympathetic nucleus S2－S4 脊髓副交感中枢 Parasympathetic nucleus
脊髓横贯性损害 Transverse lesions
高颈段（C1-4）
Spastic paralysis of all extremities
Sense loss below neck，root pain
Urinary and fecal retention，Absent
sweating Diaphragmatic paralysis，dyspnea（ C3-5 ）
Overview
脊髓横贯性损害 Transverse lesions
颈膨大（ C5－T2 ）
Spastic
paralysis of lower limbs and flaccid paralysis in upper limbs Sense loss below shoulder， Root pain in upper limbs and shoulder Urinary and fecal retention Autonomic dysfunction (Horner syndrome)
Acute myelitis

临床表现 Clinical Manifestation（一）
发病年龄 性别
Age: youth (4 y~ 83y)
Sex：male ≈female
起病形式
诱因
Episode: acute; days
Cause: postvaccinal and postinfectious Levels: Most common T3 to T5;Cervical up to C1

自主神经功能障碍 functional disturbance：
大、小便障碍等
Overview

脊髓半切综合征 Brown-Sequard Syndrome
脊髓病变平面以下同侧
的上运动神经元瘫痪
同侧深感觉丧失 对侧的痛、温觉丧失
Overview
脊髓横贯性损害Transverse lesions 原因 Major cause:

辅助检查 Laboratory
脑脊液 Cerebrospinal fluid：


Colorless and transparent
White cells and protein normal or slightly increased Glucose and chloride normal

Overview

白质 White matter：
前索 Anterior funiculus：皮质脊髓前束
主要为下行纤维
脊髓丘脑束 侧索 Lateral funiculus： 脊髓小脑束 皮质脊髓侧束 薄束 后索 Posterior funiculus： 楔束 主要为上行纤维
Overview
后角
Overview
霍纳（Horner）综合
征：瞳孔缩小，眼球 内陷，眼裂变小，面 部出汗减少。
Overview
脊髓横贯性损害 Transverse lesions
胸段（T3-12）
Sense
loss below chest or belly Spastic paralysis of lower limbs Urinary and fecal retention Autonomic dysfunction Root pain in back Segmental Abdominal reflex vanish

Acute myelitis

概念 Definition ：
是由于非特异性炎症引起脊髓白质脱 髓鞘或坏死，导致急性横贯性脊髓损害， 也称急性横贯性脊髓炎。 Acute myelitis is an acute inflammation of one or more segments of the spinal cord, which is associated with infections and vaccinations disorders.
and often last 2 to 6 weeks.
Overview
脊髓横贯性损害 Transverse lesions



损害平面的确立 节段性肌萎缩 根痛 感觉平面 反射改变
中指 胸骨角 乳头 剑突 肋弓 脐部 腹股沟
C7 T2 T4 T6 T8 T10 T12
Overview
有视力下降
Acute myelitis


Differential Diagnosis（二）
急性硬膜外脓肿 Acute epidural abscess
有化脓感染史 focus of infection 发热、根痛明显 fever, root pain 椎管阻塞明显 obstruction of vertebral canal 脑脊液细胞和蛋白增高 white cell and protein↑ MRI可帮助鉴别 MRI used for identify
脊髓休克 Spinal Shock
Overview
脊髓休克 Spinal Shock
脊髓受到急性严重的横贯性损害时，出现受损平面以下脊
髓反射活动完全消失，表现为肢体软瘫、肌张力低、腱反射消 失和病理征阴性，一般持续1－6周。In the acute stage of
spinal cord lesions, there is flaccid paralysis with loss of tendon and other reflexes, accompanied by sensory and by urinary and fecal retention. This is the stage of spinal shock,

Overview
脊髓的解剖 Anatomy of spinal cord
脊髓的外形 External features 31对脊神经: 脊髓的节段与脊柱的不一致，由 于胚胎时期脊髓的生长比脊柱慢

Overview
•
•
•
• •
C(cervical)-8 T(thoracic)-12 L (lumbar)-5 S (sacral)-5 Co (coccygeal)-1
Acute
表现Major signs :
Upper
myelitis Spinal cord trauma Spinal cord compression Hematomyelia

motor neuron paralysis (spinal shock) Loss of all sense Autonomic dysfunction
脊髓
易受感染 易破裂形成硬膜外血肿 意义不大 可反映脑的病变 注药入内进行治疗
硬膜外腔
硬脊膜
epidural cavity
硬膜下腔
蛛网膜 软脊膜
subdural cavity
蛛网膜下腔
subarachnoid cavity
Overview
脊髓内部结构 Internal Structure

灰质 Grey matter ：

Overview
Overview
脊髓损害的临床表现
Clinical Features of Different Lesions

运动障碍 motor disturbance:前角和/或锥体
束损害：运动神经元病

感觉障碍 sensory disturbance：后角和前连
合损害出现分离性感觉障碍
MRI： Enlarged spinal cord
Acute myelitis

鉴别诊断 Differential Diagnosis（一）
视神经脊髓炎 Neuromyelitis optica
Vision↓ 病变常不完全对称 Lesions are commonly incomplete symmetry 病情常有缓解及复发 Remission-relapse 可出现多灶性体征 Multifocal sign
好发部位
Acute myelitis


Clinical Manifestation（二）