D - GUNSHOT INJURIES AND STAB WOUNDS
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Two of our own cases are good examples, especially the first one who appeared
initially as a complete transverse lesion.
Case i.
M.G., aged 22, while returning home on 31 July 1967 from a public house where
she was employed was assaulted and stabbed between the shoulder blades. She was
immediately paralysed and following admission to the nearest hospital the stab wound
was explored down to T4/5 laminae. She had a complete transverse lesion on the right
below T6 and on the left below Tn. On admission to Stoke Mandeville on 3 August
1967 she showed an incomplete transverse syndrome below T6 but complete below T8
with flaccid paraplegia of both lower limbs, and areflexia of the abdominals and both
lower limbs. The sensory loss below T8 was complete without sacral sparing; bladder
and bowels paralysed. Lumbar puncture on 5 August 1967 showed an incomplete block,
protein 200 mg per cent i -2 ml red cells, 360 polymorphs and 220 lymphocytes,
bacteriological examination was negative. Haemoglobin 52 per cent. Following blood
transfusions her general condition greatly improved and on 15 August 1967, 16 days
after injury she showed the first recovery of iliopsoas, hamstrings and quadriceps on the
left side only, and the complete sensory loss was now complete below Tio. The reflexes
in the lower limbs were still absent apart from plantar flexion of the feet on plantar
stimulation. In due course the function of all muscles in the left leg returned and by 30
August 1967 there was also recovery of weak function of the proximal muscles of the
right leg. Knee and ankle jerks were still absent but plantar stimulation produced up-
going toes and withdrawal response. Following intensive physiotherapy she started
walking exercises on 5 October 1967. By that time the paresis of the lower limbs was of
spastic type and knee and ankle jerks were exaggerated. At the time of discharge on
3 February 1968 she was quite independent, walking with sticks and a BK caliper on the
right. The urine was sterile and some bladder control had returned.
Case 2.
J.U.R., on 31 January 1966, a married woman aged 28, while in her caravan
with her two small children was assaulted by being stabbed in her back with a knife. She
immediately fell down and was taken to the nearest hospital where the stab wound was
sutured. She was admitted to Stoke Mandeville on 2 February 1966 with an incomplete
transverse spinal lesion below Tio on the right with patchy hypoalgesia below L3
and areas of hyperpathia. On the left she had a patchy sensory disturbance below Tn/i2
with analgesia in L5 and patchy hypoalgesia below that level. There was also impairment
of postural sensibility below these levels. With regard to the motor function there was a
complete paralysis of the right leg with a flicker of the adductors and hamstrings only,
while on the left leg there was only a paresis of all muscles but the power in the iliopsoas,
quadriceps, inner hamstrings and dorsi and plantarflexion of the feet was quite strong.
The lower abdominal reflexes were absent and so were the knee and ankle jerks on the
right side. Plantar stimulation was negative but on the left she had a brisk ankle jerk
and a withdrawal to plantar stimulation. The knee jerk was also absent. The bladder
and bowels were paralysed and the bladder was treated with intermittent catheterization.
On 7 February 1966 she started spontaneous micturition which gradually improved and
the urine which was at first infected became sterile. On 24 February 1966 she started
getting up and taking part in all activities of the Centre. Bladder and bowel function
returned to normal. The muscles of the right leg also improved in particular the proximal
