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CHAPTER 31
injection. This is in interesting agreement with the results of Eggleton who, using very
much larger oral doses of alcohol, found that excretion was complete in 5-5 hr.
The blood alcohol concentration rose and fell much more rapidly than urine concen
tration. In view of this very rapid rise and fall in the blood alcohol concentration, blood
specimens were collected every 5 min for the first hour after injection in order to deter
mine the time of the alcohol's first crossing the CSF/blood barrier. In 3 of 9 cases in
whom blood alcohol determinations were done, a double peak was observed in the
graphs of blood alcohol against time.
Eggleton showed that the increased diuresis following oral ingestion of alcohol
showed marked variation in response in different subjects. This is also true to the response
to intrathecal alcohol. Eggleton also showed that the diuresis was in proportion to the
amount of alcohol injected. Since the amount of alcohol given to our patients intra-
thecally could not be varied over a wide range, no observations could be made in this
respect. However, we found that in several of our cases the renal secretion was found to
be suppressed during the first hour or two following the first intrathecal injection.
The outstanding result of this study is the rapid absorption of alcohol from the sub-
arachnoid space into the blood stream and thence into the urine. The maximum values
in the blood were already obtained within the first hour following injection and in one
case even within the first 20 min. Another interesting point is the observation in several
of our cases of a decrease in the rate of secretion of urine in the first hour or two after
alcohol injection. It may be speculated that this depressant effect on the renal function
may be the result of the acute transformation of the spastic lesion into a lower motor
neuron lesion.
Clinical effects
The effect of the alcohol block is illustrated in Fig. 2i8d in a case of profound intractable
spasticity in flexion and adduction. In this case it was extremely difficult to carry out an
intermittent catheterization because of the very pronounced adductor contractures
which had developed as a result of the adductor spasticity. Fig. 2i8e demonstrates the
minimal abduction which could be attained in spite of great muscular effort on the part
of the attendant. The complete relief of the intractable spasticity of the legs following
alcohol block was very striking, as seen in Fig. 2i8f. In all cases, whether flexion or
extension spasticity, the intrathecal alcohol block has proved very effective in making
the life of these unfortunate sufferers more comfortable and worth while living, and in
particular in tetraplegics, it immensely facilitated the nursing of the patients.
In thoracic and cervical lesions, the relief of spasticity in the trunk and abdominal
muscles greatly helped to restore the upright position of the patient. In those cases in
which the muscle spasms were associated with pain, the effect of the alcohol block was
sometimes dramatic (see chapter on Pain). Of special importance was the beneficial
result in the treatment of the uninhibited hypertonic bladder (Fig. 2193), in particular
the contracted bladder, which all too often was the main cause of widespread reflex
responses of both the skeletal muscles and autonomic mechanisms (autonomic hyper-
reflexia). In fact, in cases where the cystogram showed a contracted and sometimes
grossly deformed hypertonic bladder, this was the main indication for the alcohol block.
