F- CLINICAL ASPECTS OF SPINAL CORD INJURIES
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be dissociations in degree of involvement between the various components of the auto-
nomic mechanisms. Disturbances of sweating in cervical lesions may be patchy and involve
only certain segments or areas of the body below the level of the lesion. As the
Horner's syndrome at that level is of central—i.e. supranuclear type—the reflex response
of its components to afferent impulses, especially the dilator pupillae, is increased and
may lead to spasmodic pupillodilation or constriction (called by Pierre Marie in 1892 miosis
a bascules). Cocaine applied to the conjunctiva dilates the pupil in these supranuclear
lesions in contrast to its negative effect in peripheral lesions of the oculopupillary system.
Bladder, bowel and sexual function may more or less be affected in incomplete
lesions, and there may be considerable dissociations in the degree of involvement in
these functions depending on the level, type and acuteness of the lesion. Incomplete
lesions may be so light as to result in slight precipitate micturition only, on the other hand
they may for all practical purposes produce the same total retention as a complete
transection of the cord. Sexual disturbances may vary from ejaculatio praecox to com
plete impotence.
Manifestations of distinct incomplete cord lesions
It has already been pointed out that symptoms or syndromes of incomplete lesions
resulting from injury or disease depend on the degree of damage affecting the various
sections of the grey or white matter of the cord. The main syndromes which may occur
either separately or in combination are listed below.
Anterior horn syndrome
Destruction of the ganglion cells in the anterior horns leads to muscular paralysis of
lower motor neuron type. The affected muscles are atonic and there is areflexia, reaction
of degeneration and atrophy. Virus infections, in particular poliomyelitis, are the main
causes, but vascular processes such as atherosclerosis and meningovascular syphilis may
also lead to amyotrophy without affecting the pyramidal tracts. Anterior horn lesions
may involve all muscles of the extremities as well as the trunk, but as a rule spare muscles
or muscle groups scattered over a considerable area of the body resulting in dissociated
types of lower motor neuron paralysis.
Anterior horn lesions are not infrequently combined with vasomotor disturbances,
such as cyanosis and coldness as a result of an associated damage to the lateral horns.
Moreover, disturbances of sweating may also occur as studied in detail during a polio
epidemic in Silesia, Germany, in 1932 (Guttmann, 1933).
Pyramidal tract syndrome
There is a variety of intrinsic (congenital, hereditary) and extrinsic (syphilis, avitam-
inosis) degenerative processes resulting in selective degeneration of the pyramidal tracts
which are grouped together under the collective term 'Spastic Spinal Paralysis'. Amongst
the congenital varieties a spinal form of Little's disease may be mentioned which is
practically confined to the lower limbs. The same applies to a certain form of disseminated
