SLOW COMPRESSION OF SPINAL CORD. PARALYSIS.
Causes: Caries, vertebral diseases and lesions, neoplasms, actinomycosis, tubercle, abscess, organizing exudates, parasites. Melanoma, cholesteatoma, sarcoma, papilloma, lipoma, glioma, chrondroma. Symptoms: advance insensibly, or by sudden leap with exudate, spasm, paresis, transverse, senses clear, muscular atrophy, advance from behind forward. Cervical, dorsal, lumbar lesions. Bladder, sphincters, tail. Symptoms increased by movement. Treatment: according to lesion. Tumors, hopeless. Blood clots, Actinomycosis. Analgesics. Electricity.
Causes. Slowly progressive compression of the cord has been already noted as resulting from caries and other diseases of the vertebræ. It remains to notice such as result from the growth of tumors and other neoplasms in the spinal canal. In the horse these are commonly melanoma (in white horses), sarcoma, encephaloid, papilloma, cholesteatoma, and osteoma; in cattle, beside tubercle and actinomycosis, have been found sarcoma, lipoma, osteoma and glioma; and in dogs sarcoma and chondro-sarcoma. Chronic abscesses may be met with in all animals determining the same class of symptoms by slow pressure. In the same manner exudates in process of organization contract, and are liable to compress the myelon. Cadeac draws attention to a calcic degeneration of exudates in the dura mater of the dog (ossifying pachymeningitis), and of ossification of the intervertebræ cartilages with vegetations on their surfaces. Parasites also exercise a growing pressure, especially echinococcus, in cattle cysticercus mediocanellata, in sheep and dogs cœnurus, and in pigs and dogs cysticercus cellulosa.
Melanoma. In gray and white horses, with disseminated melanosis, the spinal canal is often involved, the pigmentary sarcoma appearing in small formations and sometimes large enough to determine injurious pressure. In the early stages these may cause stiffness and lameness referable to particular muscles or groups, varying in situation, even as to the limbs affected, at successive dates, and finally merging into paraplegia.
Cholesteatoma is less common than in the encephalon, yet one is reported by Dexler as attached to the pia mater and possessed of great firmness, crisply crackling under the knife. It doubtless secures accretions under meningeal exudates like those of the choroid plexus.
Sarcoma and encephaloid are usually found in connection with the dura mater, and of small size, but numerous. They often surround the roots of the spinal nerves, and here as on the cord exert sufficient pressure to impair nervous function.
Papilloma has been found connected with the pia mater and of marked vascularity. The author has found one in the ewe in a case of the neurasthenia of advanced gestation.
Lipoma is also rare. Osseous growths are common, being favored by sprains and injuries. All show a marked predilection for the lumbar and last dorsal vertebræ. This may be partly explained by the liability to injury and to disease invasion through the interlocking of the joint surfaces of the rings. Osteophytes growing from the intervertebral cartilage are common in the dorsal region as well.
Glioma has been found in cattle, occupying the substance of the cord itself and growing to the size of a hen’s egg or even of the closed fist. The cord is gradually atrophied and paraplegia is inevitable.
Chrondro-sarcoma has been found growing from the intervertebral fibro cartilage of dogs.
The Symptoms may be deferred for a length of time on account of the accommodation of the myelon to the slowly increasing pressure. When they do become manifest, it is usually at first by insensible gradations so that for a time their existence is questionable. Yet a case will sometimes reach a sudden climax, by reason of a blood extravasation or inflammatory exudate, and the signs of sudden pressure or acute myelitis or meningitis supervene. In the absence of sudden access of trouble, the symptoms are those of a slow increase of motor troubles (local paresis, paralysis, paraplegia), or sensory (hyperæsthesia, anæsthesia). Spasms may occur early or even later in the disease. From disorders due to cerebral lesions the morbid phenomena are distinguished by being paraplegic rather than hemiplegic; sensori-motor rather than sensory or motor; local rather than general; with intelligence and special senses clear, rather than dull or abolished; associated with marked muscular atrophy in the affected parts; advancing from behind forward rather than uniform throughout the body.
The area of nervous disorder points more or less clearly to the seat of the lesion. Early implication of the fore limbs, and then later of the hind, suggests lesion of the cervical region. Dyspnœa tumultuous heart action, or vertigo may coincide. Tardy movements of the hind limbs, imperfect balancing, dragging, swaying, knuckling, involuntary flexions of stifle or hock, flexor contractions, standing on toe, cramps, paraplegia, indicate lesion in the dorsal or lumbar region. There may be palsy of the rectum, anus, bladder, sphincter vesicæ, penis, and vulva. Paralysis or other nervous disorder of the tail and sphincters ani and vesicæ, without implication of the hind limbs or quarters, may bespeak lesion in the terminal end of the spinal cord.
With paralysis of the bladder the penis may be pendent out of the sheath, or being retained within it, the urine may dribble constantly into and from that cavity, and the vulva may be soft and flaccid. When the anus is involved, the adjacent part of the rectum usually participates becoming overloaded, the sphincter is soft and lax and allows a constant oozing, and the exposure of the mucosa. The paralytic tail hangs between the thighs, limp and flaccid, and becomes saturated with manure and in females with urine.
Even in the earlier stages the symptoms are usually greatly aggravated by compulsory movements like turning in a circle, walking up hill, or (in dogs) up a stair, the arched back, the pendent head, and hesitating planting of the foot suggests walking on pins. For a more exact localization of the lesion the reader may consult the table indicating the functions of the different parts of the spinal cord. The early fatigue under exercise grows as in other progressive spinal lesions.
Treatment. In most cases this is hopeless. Tumors, bony and calcic growths, tubercles, degenerations and absorption of nervous tissue are practically beyond remedy. A blood extravasation may be largely absorbed, leaving only the permanent changes in the nervous tissue. In this time is the main element. Actinomycosis may sometimes be successfully met by a course of potassium iodide, when, if the nervous lesions are slight, a fair recovery may be secured. In the majority of cases, however, the practitioner is limited to measures for palliation of suffering by atropia, chloral, phenacetin, etc., or by nerve stimulants like nux in small doses, or by weak currents of electricity. In meat producing animals, it is often the best course to fatten rapidly, or to turn over at once to the butcher.