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
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 …
