Neurological Bulletin

Author : Frederick Tilney
Publisher :
ISBN 13 : 9781332271542
Total Pages : 494 pages
Book Rating : 4.2/5 (715 download)

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Download or read book Neurological Bulletin, Vol. 1 written by Frederick Tilney and published by . This book was released on 2015-08-05 with total page 494 pages. Available in PDF, EPUB and Kindle. Book excerpt: Excerpt from Neurological Bulletin, Vol. 1: Clinical Studies of Nervous and Mental Diseases in the Neurological Department of Columbia University General Sensory. Touch. - The patient felt the touch of a finger anywhere on legs, back, and abdomen. In some places on the legs and abdomen below the nipple, it was difficult for him to recognize the prick of a pin other than as a touch. In other places the patient experienced pain when pricked with a pin. Pain. - There was a numbness of both legs, extending up the trunk to a level an inch above the nipple. There were no shooting pains nor gastric crises. There was pain between the shoulders in the region of the original injury, and where he first felt pain after he was hurt. This pain was elicited by jarring or bending forward and had persisted ever since the injury. Temperature. - He did not recognize heat or cold (presumably in area below line of sensory limit), sometimes calling the hot cold, and the cold hot. The patient was observed from time to time. The deep reflexes in legs became more active; the sensory disturbances increased until pain or temperature sensibility was more and more impaired. Supplementary General Examination. - As to rectal and vesical control, his bowels moved daily without catharsis and he had no trouble with his sphincters. For the past five months he had had trouble with starting micturition. Just above the level of the nipple, a little higher on the left side, there was a welldefined band three to four inches wide extending around the body which was distinctly hyperaesthetic. From this level down the sensation was disturbed as just described. The thoracic and abdominal organs and the cranial nerves were all normal, and the arms showed no sensory disturbances or paralysis. The weakness of the legs increased daily. On September lo and 13, lumbar punctures were made, but no fluid obtained. On September 23 a third lumbar puncture yielded about 20 c.c. of light colored amber fluid, which came out slowly, drop by drop, under low pressure. This fluid showed a marked positive Noguchi reaction and contained very few cells, mostly lymphocytes. During this time his temperature, pulse, and respiration were normal. Urine was normal; Wassermann reaction of the blood negative. There was no tuberculin reaction. Blood was W.B. C. 8,000 (polynuclears, 63%, lymphocytes, 33%, eosinphiles, 2%, basophiles, none); R. B. C. 5,120,000; hemoglobin, 87%. With the above symptoms, it was inferred that the patient was injured at the time of the scrimmage in football, and that owing to that injury, there was a subdural hemorrhage in the upper dorsal region of the cord and, perhaps, some laceration of the meninges, possibly a fracture of one of the vertebrae, although a radiograph of the spine showed no abnormality. It seemed likely that at the time of the injury there was not sufficient pressure on the spinal cord to cause any decided cord symptoms but that a lesion gradually developed which in some way compressed the cord and slowly increased the symptoms. During the month of October the weakness increased so that the patient was unable to walk. Operation was advised and the patient was sent to the first surgical division on October 27th, and Dr. Joseph A. Blake performed a laminectomy as follows: An incision from the seventh cervical to the fourth dorsal vertebra was made. Considerable bleeding was met with superficially. No evidence of a fracture or dislocation in the vertebrae could be found. The dura, when exposed, showed a little, old, fibrinous exudate. On being opened, the dura was at once expanded bilaterally by a tumor mass which resembled a large blood clot and which surrounded the cord from the seventh cervical to the third dorsal vertebra about 7.5 cm. and showed the consistency of a granuloma. The cord at this point was very much compressed so that it seemed smaller in diameter than above or below but its continuity still ex."