Diseases of the spinal cord.

  • Bramwell, Byrom, Sir, 1847-1931.
Date:
1882
Catalogue details

Licence: Public Domain Mark

Credit: Diseases of the spinal cord. Source: Wellcome Collection.

Provider: This material has been provided by UCL Library Services. The original may be consulted at UCL (University College London)

    374/400 (page 282)
    Treatment.—In the earlier stages we must endeavour to arrest the bleeding in the manner described on page 165. The subsequent treatment of the case is the same as the treatment of acute myelitis (see page 246). EXTRA-MEDULLARY HEMORRHAGE. Synonym.—spinal meningeal hemorrhage. Pathology and Etiology.—Effusion of blood into the spinal membranes is, like intra-medullary haemorrhage, ex- tremely rare. The conditions which give rise to it are:— (a) traumatic injuries, such as blows on the spine or violent concussions ; (b) pachymeningitis hemorrhagica ; (c) the rup- ture of aneurisms of the thoracic or abdominal aorta into the spinal canal; (d) purpura, scurvy, and other conditions in which a strong tendency to haemorrhage exists ; and finally, blood, which has been poured out into the cranial cavity, may find its way into the spinal canal. In some cases the blood is poured out between the dura and the bones of the vertebral canal; in others between the dura and the arachnoid. The amount of blood varies considerably in different cases; it is sometimes sufficiently copious to en- sheath the whole cord or dura ; the blood may be partly fluid, but is generally clotted and dark coloured. Onset, Symptoms, and Course.—The extravasation may occur with instantaneous rapidity, and the symptoms are then suddenly developed; in some cases the effusion is more gradual. The initial symptoms are characteristic, and are those which attend any severe meningeal irritation, viz., pain in the back, shooting-pains in the limbs or trunk, muscular cramps, twitch- ings, spasms, and rigidity. Symptoms of motor and sensory impairment are present, but the paralysis and anaesthesia are seldom great. The stage of reaction may be attended with some febrile disturbance. Prognosis.—The Prognosis is much more favourable than in the intra-medullary variety ; in many cases the symptoms gradually abate, and the patient may eventually get quite, well. A large haemorrhage into the upper part of the spinal canal may prove immediately fatal. Where the haemorrhage