{"id":4050,"date":"2025-03-12T18:24:24","date_gmt":"2025-03-12T17:24:24","guid":{"rendered":"https:\/\/kineaphp.fr\/?p=4050"},"modified":"2026-01-04T19:00:59","modified_gmt":"2026-01-04T18:00:59","slug":"les-lesions-medullaires","status":"publish","type":"post","link":"https:\/\/kineaphp.fr\/?p=4050","title":{"rendered":"Les l\u00e9sions m\u00e9dullaires : physiopathologie et grands syndromes cliniques"},"content":{"rendered":"\n<h2 class=\"wp-block-heading\">La moelle \u00e9pini\u00e8re<\/h2>\n\n\n\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-9d6595d7 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<p><strong>La substance blanche<\/strong> est constitu\u00e9e de :<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Fibres nerveuses au sein de leur gaine (faisceaux sensitifs ascendant et faisceaux moteurs descendants)<\/li>\n\n\n\n<li>Cordons m\u00e9dullaires ventraux, lat\u00e9raux et dorsaux<\/li>\n<\/ul>\n\n\n\n<p><strong>La substance grise<\/strong> (corps cellulaire) est constitu\u00e9e de :<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Corne ventrale pour la motricit\u00e9<\/li>\n\n\n\n<li>Corne dorsale pour la sensibilit\u00e9<\/li>\n<\/ul>\n\n\n\n<p><strong>Les nerfs spinaux<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Racines dorsales (sensitives)<\/li>\n\n\n\n<li>Racines ventrales (motrices)<\/li>\n\n\n\n<li>Foramen intervert\u00e9bral<\/li>\n<\/ul>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<figure class=\"wp-block-image size-full is-resized\"><a href=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/03\/image-22-png.avif\"><img loading=\"lazy\" decoding=\"async\" width=\"226\" height=\"308\" src=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/03\/image-22-png.avif\" alt=\"\" class=\"wp-image-4051\" style=\"width:196px;height:auto\" srcset=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/03\/image-22-png.avif 226w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/03\/image-22-220x300.avif 220w\" sizes=\"auto, (max-width: 226px) 100vw, 226px\" \/><\/a><\/figure>\n\n\n\n<figure class=\"wp-block-image size-full is-resized\"><a href=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/03\/image-23-png.avif\"><img loading=\"lazy\" decoding=\"async\" width=\"309\" height=\"309\" src=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/03\/image-23-png.avif\" alt=\"\" class=\"wp-image-4052\" style=\"width:244px;height:auto\" srcset=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/03\/image-23-png.avif 309w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/03\/image-23-300x300.avif 300w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/03\/image-23-150x150.avif 150w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/03\/image-23-144x144.avif 144w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/03\/image-23-80x80.avif 80w\" sizes=\"auto, (max-width: 309px) 100vw, 309px\" \/><\/a><\/figure>\n<\/div>\n<\/div>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h2 class=\"wp-block-heading\">Les voies motrices<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\">Fasiceau pyramidal (cortico-spinal)<\/h3>\n\n\n\n<div class=\"wp-block-media-text is-stacked-on-mobile\" style=\"grid-template-columns:27% auto\"><figure class=\"wp-block-media-text__media\"><a href=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/03\/image-24-png.avif\"><img loading=\"lazy\" decoding=\"async\" width=\"335\" height=\"459\" src=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/03\/image-24-png.avif\" alt=\"\" class=\"wp-image-4053 size-full\" srcset=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/03\/image-24-png.avif 335w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/03\/image-24-219x300.avif 219w\" sizes=\"auto, (max-width: 335px) 100vw, 335px\" \/><\/a><\/figure><div class=\"wp-block-media-text__content\">\n<p>L\u00e9sion sur la voie cortico-spinale : paralysie spastique<\/p>\n\n\n\n<p>L\u00e9sion sur le deuxi\u00e8me motoneurone : paralysie flasque<\/p>\n<\/div><\/div>\n\n\n\n<h3 class=\"wp-block-heading\">Les voies extra-pyramidales<\/h3>\n\n\n\n<div class=\"wp-block-media-text is-stacked-on-mobile\" style=\"grid-template-columns:24% auto\"><figure class=\"wp-block-media-text__media\"><a href=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/03\/image-25-png.avif\"><img loading=\"lazy\" decoding=\"async\" width=\"268\" height=\"256\" src=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/03\/image-25-png.avif\" alt=\"\" class=\"wp-image-4054 size-full\"\/><\/a><\/figure><div class=\"wp-block-media-text__content\">\n<ul class=\"wp-block-list\">\n<li>Faisceau rubro-spinal<\/li>\n\n\n\n<li>Faisceau vestibulo-spinal : stabilit\u00e9 du regard lorsque le corps se d\u00e9place<\/li>\n\n\n\n<li>Faisceau tecto-spinal : orientation du regard<\/li>\n\n\n\n<li>Faisceau r\u00e9ticulo-spinaux : maintien de la posture<\/li>\n<\/ul>\n<\/div><\/div>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h2 class=\"wp-block-heading\">Les voies sensitives<\/h2>\n\n\n\n<div class=\"wp-block-media-text is-stacked-on-mobile\" style=\"grid-template-columns:27% auto\"><figure class=\"wp-block-media-text__media\"><a href=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/03\/image-26-png.avif\"><img loading=\"lazy\" decoding=\"async\" width=\"312\" height=\"552\" src=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/03\/image-26-png.avif\" alt=\"\" class=\"wp-image-4055 size-full\" srcset=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/03\/image-26-png.avif 312w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/03\/image-26-170x300.avif 170w\" sizes=\"auto, (max-width: 312px) 100vw, 312px\" \/><\/a><\/figure><div class=\"wp-block-media-text__content\">\n<h3 class=\"wp-block-heading\">Voie lemniscale<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Faisceau cordonal post\u00e9rieur<\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Tact \u00e9picritique, proprioception, pallesth\u00e9sie<\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Faisceaux dorsaux de la moelle<\/li>\n\n\n\n<li>D\u00e9cussation au niveau du bulbe<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Voie extra-lemniscale<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Tact protopathique, sensibilit\u00e9 thermique, sensibilit\u00e9 algique<\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Cordon lat\u00e9ral<\/li>\n\n\n\n<li>Croise la ligne m\u00e9diane au niveau de chaque neurom\u00e8re<\/li>\n<\/ul>\n<\/div><\/div>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h2 class=\"wp-block-heading\">Les grands syndromes cliniques<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\">Syndrome transverse total<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>D\u00e9ficit sensitif \u00e0 tous les modes<\/li>\n\n\n\n<li>D\u00e9ficit moteur complet<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Syndrome de Brown-s\u00e9quard<\/h3>\n\n\n\n<p><strong>L\u00e9sion d&rsquo;une h\u00e9mi-moelle<\/strong><\/p>\n\n\n\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-9d6595d7 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<figure class=\"wp-block-image size-full\"><a href=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/03\/image-28-png.avif\"><img loading=\"lazy\" decoding=\"async\" width=\"426\" height=\"187\" src=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/03\/image-28-png.avif\" alt=\"\" class=\"wp-image-4057\" srcset=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/03\/image-28-png.avif 426w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/03\/image-28-300x132.avif 300w\" sizes=\"auto, (max-width: 426px) 100vw, 426px\" \/><\/a><\/figure>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<figure class=\"wp-block-image size-full\"><a href=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/03\/image-27-png.avif\"><img loading=\"lazy\" decoding=\"async\" width=\"500\" height=\"222\" src=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/03\/image-27-png.avif\" alt=\"\" class=\"wp-image-4056\" srcset=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/03\/image-27-png.avif 500w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/03\/image-27-300x133.avif 300w\" sizes=\"auto, (max-width: 500px) 100vw, 500px\" \/><\/a><\/figure>\n<\/div>\n<\/div>\n\n\n\n<p><strong>Homolat\u00e9ral<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>D\u00e9ficit moteur (faisceau pyramidal)<\/li>\n\n\n\n<li>Anesth\u00e9sie \u00e9picritique et proprioceptive (faisceau cordonal post\u00e9rieur)<\/li>\n<\/ul>\n\n\n\n<p><strong>Controlat\u00e9ral<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Anesth\u00e9sie thermo-algique (faisceau spino-thalamique) <\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Syndrome synringomy\u00e9lique<\/h3>\n\n\n\n<div class=\"wp-block-media-text is-stacked-on-mobile\" style=\"grid-template-columns:31% auto\"><figure class=\"wp-block-media-text__media\"><a href=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/03\/image-29-png.avif\"><img loading=\"lazy\" decoding=\"async\" width=\"481\" height=\"356\" src=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/03\/image-29-png.avif\" alt=\"\" class=\"wp-image-4058 size-full\" srcset=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/03\/image-29-png.avif 481w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/03\/image-29-300x222.avif 300w\" sizes=\"auto, (max-width: 481px) 100vw, 481px\" \/><\/a><\/figure><div class=\"wp-block-media-text__content\">\n<p>L\u00e9sion centro-m\u00e9dullaire<\/p>\n\n\n\n<p>Anesth\u00e9sie thermo-algique suspendue \u00e0 quelques m\u00e9tam\u00e8res<\/p>\n\n\n\n<p>Respect de la sensibilit\u00e9 tactile et proprioceptive<\/p>\n<\/div><\/div>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h3 class=\"wp-block-heading\">Syndrome l\u00e9sionnel<\/h3>\n\n\n\n<p>Correspond \u00e0 l&rsquo;atteinte au niveau du si\u00e8ge de la compression, \u00e9quivalent \u00e0 un <strong>syndrome p\u00e9riph\u00e9rique<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Sensibilit\u00e9 : douleur dans le dermatome, hypoesth\u00e9sie<\/li>\n\n\n\n<li>Motricit\u00e9 : d\u00e9ficit, abolition ROT dans le territoire m\u00e9tam\u00e9rique en cause, amyotrophie<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Syndrome sous-l\u00e9sionnel<\/h3>\n\n\n\n<p>Correspond \u00e0 l&rsquo;atteinte des voies longue descendantes et ascendantes au niveau de la l\u00e9sion<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Motricit\u00e9 : d\u00e9ficit moteur, syndrome pyramidal<\/li>\n\n\n\n<li>Sensibilit\u00e9 : anesth\u00e9sie\/hypoesth\u00e9sie, dysesth\u00e9sies<\/li>\n\n\n\n<li>Troubles v\u00e9sico-sphinct\u00e9riens, ano-rectaux, g\u00e9nito-sexuels<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Phase 1 : choc spinal<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Paralysie flasque : paralysie compl\u00e8te (volontaire et r\u00e9flexe)<\/li>\n\n\n\n<li>Anesth\u00e9sie \u00e0 tous les modes<\/li>\n\n\n\n<li>Fonction neurov\u00e9g\u00e9tative alt\u00e9r\u00e9e : troubles circulatoire, de la r\u00e9gulation thermique, digestif, v\u00e9sico-sphinct\u00e9riens<\/li>\n\n\n\n<li><\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Phase 2 : automatisme m\u00e9dullaire<\/h3>\n\n\n\n<p>A 2 semaines &#8211; 2 mois<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Persistance des troubles sensitivo-moteurs<\/li>\n\n\n\n<li>Paralysie spastique : r\u00e9apparition des ROT et apparition de la spasticit\u00e9<\/li>\n\n\n\n<li>Cons\u00e9quences : exag\u00e9ration ROT (vifs, polycin\u00e9tiques, diffus\u00e9s), hypertonie spastique, spasme en flexion\/extension, contractures<\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"<p>La moelle \u00e9pini\u00e8re La substance blanche est constitu\u00e9e de : La substance grise (corps cellulaire) est constitu\u00e9e de : Les nerfs spinaux Les voies motrices Fasiceau pyramidal (cortico-spinal) L\u00e9sion sur la voie cortico-spinale : paralysie&hellip;<\/p>\n<p class=\"more-link-wrapper\"><a href=\"https:\/\/kineaphp.fr\/?p=4050\" class=\"more-link\">Continue Reading<span class=\"screen-reader-text\"> \u00ab\u00a0Les l\u00e9sions m\u00e9dullaires : physiopathologie et grands syndromes cliniques\u00a0\u00bb<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[406],"tags":[],"class_list":["post-4050","post","type-post","status-publish","format-standard","hentry","category-champ-neuro-atteinte-medullaire"],"_links":{"self":[{"href":"https:\/\/kineaphp.fr\/index.php?rest_route=\/wp\/v2\/posts\/4050","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/kineaphp.fr\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/kineaphp.fr\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/kineaphp.fr\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/kineaphp.fr\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=4050"}],"version-history":[{"count":15,"href":"https:\/\/kineaphp.fr\/index.php?rest_route=\/wp\/v2\/posts\/4050\/revisions"}],"predecessor-version":[{"id":7955,"href":"https:\/\/kineaphp.fr\/index.php?rest_route=\/wp\/v2\/posts\/4050\/revisions\/7955"}],"wp:attachment":[{"href":"https:\/\/kineaphp.fr\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=4050"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/kineaphp.fr\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=4050"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/kineaphp.fr\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=4050"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}