Shell-shock: Hemiparesis, amnesia. Lumbar punctures early (but here as late as one month after shock and after disappearance of hemiparesis) showed PLEOCYTOSIS and hyperalbuminosis.
Case 205. (Souques, Megevand and Donnet, October, 1915.)
A French sergeant, a machine gunner, was the victim of shell-burst September 25, 1915, was evacuated with a diagnosis of commotio cerebri, and, when examined at Paul-Brousse October 5, showed a right-sided hemiparesis, clouding of consciousness and somnolence, the hemiparesis involving the face, with deviation of tongue to right, Babinski reflex right, cremasteric and abdominal reflexes abolished on right. Normal respiration and pulse.
Lumbar puncture October 7, that is, thirteen days after the injury, yielded a clear fluid with an excess of albumin, 144 small lymphocytes (some degenerate) and a single endothelial cell.
October 12, the knee-jerk was a little less lively on the right side. The plantar reflex varied between extension and flexion on the right side. The cremasteric reflex had been weakly regained on the right side.
The patient was now less stupid and could tell how he jumped when the shell burst, and how he had been in the air ten minutes (!) and fell, getting up at once, with nothing wrong except nosebleed. After a half-hour he felt weaker and was ordered to leave the post, whereupon, on the road, his weakness increased and he tended to fall to the right, but reached the ambulance on foot.
October 23, there was no longer any evidence of hemiparesis, the Babinski reflex had entirely disappeared; there was no complaint except of dizziness and headaches. He got back his autocritique on the matter of remaining in the air ten minutes, but there was still an amnesia for the ten day period between the shock and his arrival at Paul-Brousse. He forgot that he had had a lumbar puncture October 7.
Another puncture, October 25, yielded some 14 or 15 lymphocytes to the cmm. There was still an excess of albumin. The lymphocytes decreased further according to a puncture November 2. Had this patient been examined some weeks after the shock there would have been no signs of an organic paresis, no special modification of the spinal fluid, and no reason for regarding the man as other than an hysteric. Early spinal puncture is, accordingly, important.
Of course, the question whether the lymphocytes and hyperalbuminosis of the fluid might not be syphilitic must be raised. At the Hospital Medical Society meeting, October 29, 1915, Souques states that Ravaut and Guillain believe that simple shell-shock often produces “syphilitic” chemical, physical or cytological changes in the spinal fluid. Roussy is cited as thinking such changes rare.