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CHAPTER 8
months after operation she made a complete recovery of all clinical symptoms, could do
full house work and take long walks. In another case of meningeoma removed by the
writer, the patient a woman, aged 41 had an almost complete paraplegia below T4.
At operation, the matrix of the tumour was found on the anterior surface of the dura
developing shaft-like posteriorly and with its main bulk compressing the cord to a thin
band which was riding on top of the tumour. However, following total removal of the
tumour, the cord expanded, even during the operation, almost to its normal size and the
patient made a complete functional recovery within a few weeks and in due course
resumed mountaineering.
In this connection, the case of a traumatic paraplegic woman may be mentioned which
the writer reported at the 1966 Annual Meeting of the International Medical Society
of Paraplegia during the discussion on a paper by Wolman on axon regeneration after
spinal cord injury. This patient had a complete transverse cord syndrome following
fracture dislocation at T5 level of 27 years duration. During the last few years, the patient
had complained of pain in her lower back radiating into the left leg. On examination, I
found that she had definitely some appreciation to deep pressure with correct localization
in the left leg. I had known her symptomatology for many years, but it was the first time
that this appreciation to deep pressure on the left side only was discovered. Wolman
(1966) found evidence of well-developed axon regeneration in or near the damaged
segments in 12 out of 76 patients with traumatic paraplegia, the time lapse after injury
ranging from 12 months to 32 years. The regenerating axons occurred in small bundles
both above and below the level of the maximal cord damage in three cervical, five thoracic
and four lumbar cases. A very frequent site of bundles of regenerated nerve fibres was in
the pia arachnoid on the dorsolateral aspects of the cord above the level of the maximal
damage and in the dorsolateral quadrant of the cord near the dorsal root entry zone. The
origin of these nerve fibres was clearly in the posterior nerve roots and ganglia. Although
there is no proof as yet of true motor and sensory recovery in man following transection of
the cord, the now greatly increased life expectancy of traumatic paraplegics and tetra-
plegics, as a result of the advances made in the treatment during the last 25 years, has
opened new opportunities to study this important problem in man by a close co-operation
between clinicians and neuropathologists. The preconditions are detailed clinical
records of the initial stage of the cord lesion and careful and systematic neurological
check-ups with special reference to motor and sensory functions over a period of many
years. Only then will a proper correlation between such histological findings, as described
by Wolman (1966) and others, and the clinical symptomatology be possible.
