Semiotics of Sensitivity

 

1- lesions of the spinal cord:

A- Syndrome cordonale post:

* Paresthesia; Lhermitte’s sign (shock sensation-clenchée by flexing the neck)

* Disorders discriminative sensitivity (position sense); astereognosis

* Ataxic disorders

B- syringomyelic Syndrome:

* Responsible lesion is in the gray matter intramedullary

* Achievement dissociated sensitivity on thermal and painful sensitivities and respecting the tactility

* Suspended Territory (at the same level of injury)

* The zone of anesthesia is bilateral but asymmetric

Semiotics of sensitivity

Semiotics of sensitivity

C- spinothalamic Syndrome:

* Thermal and painful anesthesia of any part of the underlying hémicorps contralateral to the lesion.

* The touch sensitivity, sense of position, are kept pallesthésie

* It is expressed in the territory under the lesion

D- The Brown-Sequard syndrome:

* Matches injury of a hemi-cord and associates

* A posterior cordonal syndrome side of the lesion

* A spinothalamic syndrome opposite side

2- lesions of the trunk:

Wallenberg syndrome:

* Lateralized lesions of the pontomedullary region

* Provides an alternate sensory syndrome with:

* Thermal and painful hemianesthesia of hémicorps the opposite side

* Thermal and painful anesthesia of the face on the side of the lesion (V)

3- thalamic lesions:

* Disorders sensory discriminative objectives defined position, location, and tactile discrimination, pallesthésie, ataxic unstable hand, astereognosis.

* Achievement of thermal and painful sensitivity which thresholds are high
(Stimulation must be intense to be effective).

* The pain is felt the hard way, diffuse, extended ..

* Spontaneous thalamic pain interesting hemibody the side opposite the lesion (hyperpathia).

* Thévenard Syndrome (acropathie necrotizing)

* Tabes (syphilis) radiculo-cordonal posterior syndrome

* The parietal astereognosis is characterized by the inability to identify objects by palpation and the absence of significant disturbances basic sensibilities (actually there is a disruption of sensory discrimination).

* Achievement parietal -> especially interested in cheiro-oral sensitivity

4- chronic pain:

A- somatic pain:

* The nervous system is in normal principle

* This is a nociceptive pain; pain control mechanisms are overwhelmed (osteoarticular, visceral …)

B- neurogenic pain:

* This is usually by deafferentation pain or lack of inhibition caused by injuries to the peripheral nervous system or central

* Either spontaneous; after normally painless stimulation (allodynia)

C- psychogenic pain:

* Painful states with predominantly emotional or interpretive dimension in pain experienced

* Variable Meanings: masked depression, hysteria, hypochondria …

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