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CHAPTER 22
operated upon one day later and the spinal cord was found almost completely severed
by a foreign body, which was removed. A suprapubic cystostomy was performed on the
same day, a procedure which was also done in the other cases described leading to infec
tion. There were also pressure sores in the last two cases. On admission to Stoke Mande-
ville 3 days later, there was a complete flaccid paraplegia below Ti with paralysis of the
abductor pollicis longus and brevis and slight weakness of the long finger flexors on the
right side which later recovered completely. The paralysis of the lower limbs and trunk
was flaccid and there was a complete sensory loss below Ti on the right and T2 on the
left with an incomplete Homer's syndrome on the right. The pattern of reflex return in
the lower limbs and abdominals is shown in Table 8.
TABLE 8. Complete transverse lesion below Ti/2
1.11.44
27.11.44
19.12.44
26.2.45
R
L
R
L
R
L
R
Abdominals
—
—
—
—
—
—
—
Cremasterics
-
-
—
—
KJs.
-r-r
(clonus)
AJs.
--
-
-f
+
++-T +
(clonus)
Plantars
!
I
\
t
Withdrawal response
—
+-f
+ -r
^ -f
(flexion
(flexion
synergy)
adduction
synergy)
These cases demonstrate the variability of reflex return following spinal shock. It
may be noted that the cremaster reflex has been absent throughout and remained so. The
absence or late return of this reflex, which I confirmed again and again, is not in accord
ance with other authors who claim that the cremasteric reflex usually returns early
(McCouch, 1964).
Varieties in reflex-pattern
Four groups may be examined, in which certain muscles or muscle groups become
dominant in the reflex synergy.
I.
Preponderance of the extensor hallucis longus and tibialis anterior
The contraction of the extensor hallucis longus on plantar stimulation represents one
of the original components of both extensor and flexor synergies. It is indeed one of the
very early signs of any reflex activity of the isolated cord. Although this reflex was first
