ryggmargens nevroanatomi kliniske begrep, nov 2014 inm versjon
TRANSCRIPT
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Ryggmargens nevroanatomi ,
kliniske begrep.
Tom Tørhaug
Overlege
Spesialist i Fysikalsk medisin og Rehabilitering (snart)
ph.d student NTNU-DMF-Institutt for Nevromedisin
Senior rådgiver, Avd Statistikk og Kodeverk, Helsedirektoratet
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• Segmentell anatomi
• Spesiell anatomi
• Autonom reguleringssvikt
• Ryggmargens plastisitet
• Autonom dysrefleksi (AD)
Disposisjon
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Date of download: 10/8/2014 Copyright © 2014 American Medical
Association. All rights reserved.
From: The History of Dermatome Mapping
Arch Neurol. 2003;60(1):126-131. doi:10.1001/archneur.60.1.126
Sir Henry Head's 1893 dermatome maps. Minor variations of these maps are frequently reproduced in current clinical texts.
Reprinted with permission from Oxford University Press, Oxford, England.
Figure Legend:
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Segmentell anatomi
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• http://isncscialgorithm.com/
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Autonom reguleringssvikt
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Ryggradens anatomi
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forts….
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forts…
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Medulla spinalis, ryggmargen
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Ryggmargens sensomotoriske baner
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Ryggmargens autonome baner
• Utgår primært fra hypothalamus følger laterale funiculus og ender stort
sett i intermediær grå substans i hhv Th1-L2 og S2-S4.
• Alle ryggmargsskader gir autonom reguleringssvikt.
• Hud,blære,tarm,sex,hjerte,kar….
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Ryggmargens blodforsyning
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Ryggmargens blodforsyning
Griepp EB, Luozzo GD, Schray D,
Stefanovic A, Geisbüsch S, Griepp RB. The anatomy of the
spinal cord collateral circulation. Ann Cardiothorac Surg
2012;1(3):350-357. DOI: 10.3978/j.issn.2225-319X.2012.09.03
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Ulike tilstander
• Tumores
• tRMS
• Infeksiøs eller autoimmun myelitt
• Cervikal spondylitisk myelopati
• Vaskulære hendelser
• Bakteriell infeksjon
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Den levende ryggmargen
• en svipptur innom…
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Utviklings- stigen (the law of evolution) Northcutt RG. Evolution of the vertebrate central nervous system: patterns and processes. Am Zool 1984; 24: 701–716.
Alder Kennard effekten
-rotte, katt, mennesker
Cangiano, Hill & Grillner , Neuroscience 2012
Grillner S, Science 2011
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Likheter mellom hjerne og ryggmarg
• Ryggmargen er ikke et bredbånd !
• ..men en veldig kompleks nervestruktur som:
– tilpasser seg
– har lærings og hukommelses egenskaper
• Illustrert ved:
– Enkle reflekser
– Smerte signaler
– Sammensatte motoriske oppgaver
«the final common pathway»
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CPGs Grillner, S., McClellan, A., and Perret, C. (1981) Entrainment of the spinal pattern generators for swimming by mechanosensitive elements
in the lamprey spinal cord in vitro. Brain Research 217: 380-386. Grillner, S. (1985) Neurobiological bases of rhythmic motor acts in vertebrates.
Science 228: 143-49.
• Ryggmargen opprettholder en innebygd egenskap til å styre og
koordinere rytmiske motoriske bevegelser, for eksempel i beina.
• Dette gjøres i nettverk av nerver i et gitt segment av ryggmargen.
• Slike nettverk av nerver kalles vanligvis «sentrale mønster
generatorer» eller central pattern generators (CPGs) .
• CPGs finnes hos alle virveldyr og virvelløse dyr, men enkelt arter har
særegne egenskaper.
Courtine, G; Nat Neurosci. 2009 October ; 12(10): 1333–1342. doi:10.1038/nn.2401.
Sten Grillner
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Nevrale nettverk: perspektiv fra niøye fisk
Grillner S, Nature reviews. Neuroscience 2003 Vol: 4(7):573-586.
i.e. ventral thalamus
i.e between mesecephalon and pons
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• Dette betyr at ryggmargen har nettverk tilstrekkelig til å styre og
koordinere tett opp til normale bevegelses mønster, og dette skjer I
fravær av signaler fra hjernen.
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Autonom dysrefleksi (AD)- hva
skjer ?
..om AD og viktig å huske på..
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Symptomer og tegn
• Plutselig høyt blodtrykk
• Dundrende hodepine
• Lav hjertefrekvens
• Rødme I huden over skade nivå
• Utbredt svetting over skade nivå
• Blek hud, gåsehud
• Skjelvinger uten feber
• Tett nese
• Uskarpt syn
• Kortpust, angstfølelse
• Irritabilitet, uro, voldsomheter
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Referanser
• Bashford G. Medical management of spinal cord impairment. Autonomic Dysreflexia. Current Therapeutics 1997, 65-71.
• Consortium for Spinal Cord Medicine. Clinical Practice Guidelines: Paralysed Veterans of America, All issues
• Dunn K. Identification and Management of Autonomic Dysreflexia in the Emergency Department. Topics in Emergency Medicine; Jul-Sep
2004; 26: 3.
• Esmail Z, Shalansky KF, Sunderji R, Anton H, Chambers K, Fish W. Evaluation of captopril for the management of hypertension in autonomic
dysreflexia a pilot study. Archives Physical Medicine Rehabilitation 2003; 83: 604-608.
• Grossman E, Messerli F, Grodzicki T, Kowey P. Should a Moratorium Be Placed on Sublingual Nifedipine Capsules Given for Hypertensive
Emergencies and Pseudoemergencies? Journal of the American Medical Association 1996; 276: 1328-1331.
• Krassioukov A, Claydon VE. The clinical problems in cardiovascular control following spinal cord injury: an overview. Progress in Brain
Research 2005; 152C: 223-229.
• Krassioukov A, Warburton D, Teasekk R, Janice J A. Systematic Review of the Management of Autonomic Dysreflexia After Spinal Cord
Injury. Archives Physical Medicine Rehabilitation 2009; 90: 682-695.
• Weaver LC. What causes autonomic dysreflexia after spinal cord injury? Clinical Autonomic Research 2002; 12: 424-426.
• Lin VW, Cardenas DD. Spinal cord medicine. Principles and practice. 2 ed. New York: Demos; 2010. xxiv, 1043 s. p.
• Spinal Cord Injury ,First Edition, Anders Holtz, MD, PhD and Richard Levi, MD, PhD, 2010, ISBN: 9780195372762
• Waters RL, Adkins RH, Yakura JS. Definition of complete spinal cord injury. Paraplegia. 1991;29(9):573-81.
• Waring WP, 3rd, Biering-Sorensen F, Burns S, Donovan W, Graves D, Jha A, et al. _ 2009 review and revisions of the international standards
for the neurological classification of spinal cord injury. J Spinal Cord Med. 2010;33(4):346-52.
• http://www.wingsforlifeworldrun.com/no
• http://www.iscos.org.uk/
• http://www.asia-spinalinjury.org/