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CHAPTER 16
1035:
Says he 'is feeling not too bad* but cannot see or recognize anybody.
1054:
Clearer. Can now distinguish torchlight flashed in front of eyes.
noo: Can distinguish finger movements, speaking coherently.
1105-15: Can recognize light of matches and torch but no objects.
1120:
Says he does not know 'what all this is about*.
1125:
Saw a match being moved, but no shape; becomes emotional and cries. After
a few minutes: 'what made me cry then ?'
1135:
Recognizes objects, shape and colour (banana, pen, glass, matchbox and flowers
with colours).
1145:
Holding normal conversation but vision slightly blurred.
1155:
Movement in hands and fingers returned as have reflexes and spasms in legs.
It is assumed that in this case a small pulmonary embolism elicited a profound cardio
vascular reflex-response leading to prolonged spasm in the posterior cerebri arteries
resulting in blindness. The gradual return of vision with later return of colour vision is
indicative of a temporary lesion of the calcarina-posterior lobe area.
This man was discharged home on 19 November 1959 having recovered finger
muscles on his right hand. He is still alive and fit (last clinical check up 7 July 1971).
Prevention and treatment
It is essential as far as possible to prevent pressure to the calves in the acute stage by
frequent turning of the patient from the supine to the lateral position, and this should be
combined with elevating the foot end of the bed to facilitate venous return. Electrically
controlled turning and tilting beds are most useful in this respect, as they facilitate the
work of the nursing staff. Breathing exercises should be added and resistance exercises
with the aid of chest expanders should be started as early as possible in the absence of
haemothorax and fractures of ribs to improve the blood circulation and venous return.
Blood transfusion should not be given through veins of the paralysed limbs in order
to avoid clotting and thus venous thrombosis.
Benassy (1965) emphasized the danger of second transportation from one hospital
to a spinal centre without previous preventive therapy by anticoagulants. This again
speaks for immediate admission of traumatic paraplegics and tetraplegics to a spinal
centre within the first 24 hours after injury.
For some time there has been uncertainty as to the indications of anticoagulant
therapy and time of its commencement. However, the trend now is to start this treatment
routinely very early provided that regular estimation of prothrombin efficiency is avail
able to prevent overdosage. The anti-coagulant therapy is most effective at 30 per cent
and less of prothrombin efficiency. This treatment can be divided into emergency and
preventive treatment. Emergency treatment is indicated in coronary thrombosis as well
as in deep venous thrombosis and pulmonary embolism in traumatic paraplegics and
tetraplegics. Pularin (Heparin-Evans) will provide a rapid therapeutic effect following
intravenous injection of 10,000 I.U. which will last about 4 hours. Intramuscular
injection of Pularin of 7,500-10,000 I.U. given at the same time will cover for 8-12
hours after the effect of the intravenous dose has worn off. This treatment should be
