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)

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    are seldom present, and the patient may live for a considerable time after the paraplegia has been developed; but in the vast majority of cases the termination is fatal. Diagnosis—The diagnosis is sometimes easy, but often uncertain or impossible. Symptoms of meningeal and nerve- root irritation (viz., pain in the back, and irritative sensory and motor phenomena in certain nerve districts), together with symptoms of compression of the cord, demonstrate the presence of an extra-medullary lesion; and we may conclude with considerable probability that the lesion is a tumour, when: (1.) The symptoms have developed slowly, and are not attended with fever. (2.) The lesion appears to be of limited vertical extent. (3.) There is no evidence of Pott's disease of the spine, and no history of a dislocation or fracture of the vertebrae. When in addition to this evidence the presence of a can- cerous, scrofulous, hydatid, or syphilitic growth can be demon- strated in some other part of the body, the diagnosis of extra- medullary tumour may be made with great certainty. The position of the tumour and its vertical extent are to be ascertained by observing— 1. The exact distribution of the irritative phenomena which result from pressure upon the anterior and posterior nerve roots. The particular nerve roots which are implicated can in this manner be ascertained. 2. The condition of the reflexes and the trophic condition of the muscles. 3. (In the case of a unilateral lesion of the cord e.g., a tumour pressing upon one side of the cord), the position and vertical extent of the anaesthetic band on the same side as the lesion. (See fig. 74.) 4. The exact position of the pain in the back. The pain which results from pressure on the membranes, or from cancer of the vertebrae, may be strictly localised, and so may afford corroborative evidence as to the exact position of the tumour. Again a local alteration of the spinal columns, such as an external tumour or thickening of the bones, may indicate the position of the internal tumour. It is important to remember that the spinal cord terminates at the lower border of the first lumbar vertebra; and that the greater number of the