Diseases of the Spinal Cord by E. M. R. Critchley, A. A. Eisen (auth.), Edmund Critchley

By E. M. R. Critchley, A. A. Eisen (auth.), Edmund Critchley DM, FRCP, Andrew Eisen MD, FRCP(C) (eds.)

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A hemispheric lesion, whether cortical or capsular, produces a spastic hemiparesis with hypertonia of the flexor muscles of the arm and extensor muscles of the legs and a corresponding weakness of the antagonistic extensors and flexor muscle groups respectively. In all forms of spasticity tonic activity of the anterior horn cells is accompanied by an increased sensitivity to peripheral afferent input. There is a lowered threshold for the activation of withdrawal reflexes. Proprioceptive afferents from the tension receptors and muscle spindles enhance the degree of spasticity.

1979). These authors have provided anatomical evidence that the initial haemorrhage was of a radicular artery and argue that any subarachnoid blood would have been cleared by CSF hydrodynamics. Haemorrhage into Subarachnoid Space This arises as a result of trauma to radicular arteries (Masdeu et al. 1979) and may cause an acute spinal cord or cauda equina syndrome, particularly in those on anticoagulants. Brem et al. (1981) reviewed their experience of LP in patients who were put immediately onto heparin: 3 of 175 patients developed paraparesis, of whom 2 had a subarachnoid haematoma, in 1 the LP had been acellular.

1985). It may be better to treat first and base a bacteriological diagnosis on clinical grounds and blood culture (Harper et al. 1985; Shapiro et al. 1986). Complications of the Technique Spinal anaesthesia has provided useful data on the incidence of traumatic complications from LP in experienced hands. Dripps and Vandam (1951) reported that complications were rare and were usually related to the dural puncture rather than the anaesthetic agent. They attributed complications to three processes: trauma, changes in CSF pressure and infection.

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