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TRAUMA IN RELATION TO DISSEMINATED SCLEROSIS.
By A. Turner, M.R.C.S., L.R.C.P., Senior Assistant Medical Officer,
Fulham Hospital.
The difficulties of diagnosis in the following case seem to merit description:—
Miss F. A., aged 50 years, was admitted on 6.11.34 as a case of spinal concussion.
History—She had fallen on her back on 3.11.34 in the street, having slipped on a steel road
stud of a pedestrian crossing. She was positive that she had been quite well before this fall,
also that she had not struck her head in falling. She was able to get up. and then made her way
home with assistance. The next day she found she had lost power and feeling in her lower
limbs. Her doctor duly sent her into hospital on 6.11.34 with the diagnosis of spinal concussion.
On admission—She was a well-nourished healthy looking woman, intelligent, but rather
deaf. Temperature 103°, which subsided to normal next day. On examination, the knee jerks
were brisk, with a double Babinski and absent abdominal reflexes. There was fair range of
movement of the lower limbs, but sensation to pin-prick and cotton wool were somewhat delayed;
occasional incontinence of urine; no nystagmus or intention tremor, and the optic
discs appeared normal.
The cerebrospinal fluid was under increased tension but quite clear. Appearance: colourless,
clear, waterlike. Protein: 40 mg. per 100 c.c. Globulin: no increase. Chlorides: 775
mg. per 100 c.c. Colloidal gold: 123431000. W.R. and K.R. both negative. The blood
Wassermann reaction was also negative.
By 14.11.34 there had developed a spastic paresis with loss of sensation up to an indefinite
level—about D6 for pin-prick and about D8 for cotton-wool. Compression paraplegia following
trauma appeared a probable diagnosis.
As improvement was very slow a cistern puncture with injection of Lipiodol was done,
but the X-ray showed no evidence of any obstruction. On 28.11.34 there appeared to be a
general improvement all round, the sensory level to pin-prick having faded down to Dll/12.
The double Babinski was still present.
Signs of cystitis developed about 9.12.34 with a swinging temperature until death. On
12.12.34 there was practically no neurological change, and the general condition was stationary.
The acute cystitis persisted. On 25.12.34 the patient suddenly collapsed and died.
Post-mortem report on spinal cord—Areas of degeneration were found in: (1) anterior part
of right centrum semi-ovale; (2) antero-lateral column in 5th cervical segment of spinal cord;
(3) postero-lateral column in 5th thoracic segment; (4) lateral column in 9th thoracic segment;
(5) both antero-medial columns and one lateral peripheral zone in 3rd lumbar segment. On
other organs. (1) chronic cystitis; (2) purulent ascending pyelo-nephritis; (3) congestion
and cloudy swelling of liver; (4) oedema and very slight acute inflammatory infiltration of
spleen; (5) oedema of lung.
I wish to express my thanks to Dr. C. D. Coyle, medical superintendent, for
permission to publish this case and for his help and counsel; also to Dr. D.
Brinton, consulting neurologist, for his most courteous assistance in a very
baffling case.
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