B • ANATOMY, NEUROPATHOLOGY AND REGENERATION
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Marburg (1936) described as Vasopathia traumatica' post-traumatic alterations of
the vascular supply leading to thrombosis and softening of the tissues. Ziilch (1954)
described pencil-like softening of the thoracic cord following cervical injury as a result
of defective blood circulation. However, there are discrepancies of opinion amongst
workers in this field regarding details of the vasogenic origin of the remote post-
traumatic cord lesions (Becker & Hess, 1954; Becker, 1958; Schneider, 1955; Tonnis,
1963).
One of the latest cases of late development and progression of the spinal sympto–
matology I have seen is a woman, aged 51, who sustained a complete paraplegia below
T4/5 on 2 August 1969 following fracture of the spine. She was treated originally at the
Spinal Injuries Centre, Oswestry. In February 1970 (7 months after injury) she experi–
enced unpleasant tingling sensation around the right elbow which gradually spread over
the right arm and neck and also over forearm and fingers of the right hand. Moreover,
she noticed clumsiness in her right hand and fingers, especially when knitting. On
examination she had, in addition to a complete transverse lesion below T4 of spastic
type in extension, a thermo-analgesia below C2 on the right side. There was also impair–
ment of postural sensibility in the fingers of the right hand, especially the 4th and 5th and
there was slight ataxy in the right arm on finger-nose test. The deltoid, triceps and supi-
nator reflexes were absent on the right side but present on the left. Of special interest
was the cutaneous vasomotor response to a stroke or needle prick over the whole area
of analgesia, as compared with the corresponding normal areas of the left side. Every
stroke and needle prick produced marked and long lasting weal eruption, while on the
corresponding areas of the left side the same stimuli produced the normal short-lasting
local vasodilatation surrounded by a small line of vasoconstriction.
Motor function in all muscles of the right upper limb, including finger and thumb
muscles, were intact. In this case, the late development of post-traumatic vascular
pathology, most probably of thrombotic nature, has affected the distribution of the right
posterior spinal artery, resulting in gradual ascending deterioration of the right posterior
horns up to C2 and to a lesser degree also of the posterior column on the same side. That
this has resulted in softening of the affected tissue forming a tapering pencil-like cavitation
can only be assumed at the present juncture.
Another case of this type is a former naval lieutenant (I.S.) aged 26, who on 30 July
1969 was involved in a car accident while a front seat passenger. He sustained a complete
paraplegia below the chest as a result of a fracture dislocation of the 5th/6th dorsal
vertebra. He was up in a wheelchair 6 weeks after the injury and took part in all the
activities of the Lodge Moor Spinal Injuries Centre where he was treated.
During his stay in hospital he noticed one day that he could not feel cold in his left
hand and arm. This impairment of sensation to temperature and also to painful stimuli
increased in due course until it reached the left side of the neck.
When I saw this man first in 1970 he had a complete motor paralysis below T5 with
loss of control of bladder and bowels, but the sensibility below that level was not com–
pletely lost. However, he had a dissociated sensory loss over the whole left arm, neck,
including the 2nd and 3rd cervical segment.
On re-examination on 7 July 1972 the neurological condition below T5 was unchanged
