4 Transactions of the Pathological Society of London, vol. vii., 1856.
A special form of the disease, occupying chiefly the cervical region, was first described by Charcot.5 The membrane is thickened by a deposit of successive layers of fibrin, compressing the cord, which is flattened from before backward and inflamed. The nerve-roots are also more or less compressed. The course of the disease may be divided into two stages: First, that of irritation of the spinal nerves, with pain in the back part of the neck, extending to the head and along the upper limbs. The pain is permanent, but liable to exacerbations, and is accompanied with stiffness of the neck and a feeling of numbness and tingling, with muscular weakness of the arms. Sometimes the skin of the arms is the seat of trophic changes, as shown by the presence of bullæ or pemphigus. The second period is that of extension of the disease to the cord. The pain ceases, and is followed by paralysis or muscular atrophy, especially in the domain of the ulnar and median nerves, resulting in extension of the hand on the forearm, with flexion of the fingers toward the palm, giving rise to a claw-like appearance (main en griffe). In some cases an upward extension of the disease implicates the root of the radial nerve, and the hand then assumes a prone position from paralysis of the extensor muscles. The lower portion of the cord may also become involved, with similar results in the lower extremities. Although the disease is generally progressive, it is not always so, and Charcot cites one case in which great improvement took place in the course of some years, though not apparently in consequence of any special treatment.
5 Leçons sur les Mal. du Syst. nerv., par J. M. Charcot, Paris, 1875, vol. ii. p. 246. See, also, Maladies du Syst. nerv., par A. Vulpian, Paris, 1879, p. 127; and Clinique méd. de l'Hôpital de la Charité, by the same.
Acute Spinal Meningitis.
SYNONYM.—Leptomeningitis spinalis acuta.
By the term spinal meningitis is usually meant inflammation of both the arachnoid and the pia, the two being, as already stated, in reality one membrane. In connection with meningitis of the brain it constitutes a distinct disease which is usually epidemic, and probably zymotic in its origin. (See EPIDEMIC CEREBRO-SPINAL MENINGITIS.) Sporadic spinal meningitis is a rare disease. It may be acute or chronic.
ETIOLOGY.—Among the causes of acute spinal meningitis are injuries to the vertebral column, such as fracture and dislocation from falls, blows, etc.; wounds by stabbing or shooting; violent bodily effort, as in lifting heavy weights, etc. Other causes are local exposure to wet and cold, as from sleeping on the wet ground or standing long in water while at work. Like cerebral meningitis, it may complicate constitutional diseases, as rheumatism, pyæmia, etc., but less frequently than the former. Syphilitic inflammation of the spinal membranes is, however, not unfrequently met with, but chiefly of the chronic form. (See the article on SYPHILIS OF THE BRAIN AND SPINAL CORD.) In tubercular meningitis of the brain the pia mater of the cord is often implicated in the disease. Acute spinal meningitis is most frequently met with in young persons, and is more common in men than in women.
SYMPTOMS.—The onset of the disease is generally sudden, and it is rarely preceded by the usual inflammatory symptoms of chilly sensations, restlessness, headache, etc. A sharp rigor is the first indication of disease in most cases. This is followed by fever, with high temperature and a quick, full, hard pulse. Pain in the back follows, either confined to a limited region or extending throughout the whole extent of the spine, soon becoming acute, and aggravated by any movement of the trunk or even of the limbs. There is usually but little tenderness on pressure upon the spinous processes, and often none at all. The pain extends around the body and throughout the limbs. In the course of a few hours muscular contraction in the region of the back, and also of the limbs, is observed. When the disease is situated in the cervical region, the head is drawn backward, and cannot be moved without severe pain. If it occupies a considerable extent of the spine, the dorsal muscles become rigidly contracted and the body is arched forward (opisthotonos), as in tetanus, so that the patient may even rest upon his occiput and sacrum. Owing to the implication of the muscles of respiration, more or less dyspnœa is common, and may even cause death by asphyxia. There is no paralysis of the limbs, unless there be complication of myelitis, but the patient abstains as far as possible from any movement from dread of pain. Reflex irritability is exaggerated. Retention of urine and constipation are common, probably for the same reason. Hyperæsthesia of the surface of the body in limited areas is sometimes noticed, owing to the irritation of the posterior spinal roots. Provided the extent of the inflammation be comparatively limited, recovery is possible, though rare, at this stage of the disease.
When the course of the disease is unfavorable, symptoms of paralysis appear, from compression of the cord by the products of inflammation. The hyperæsthesia of the skin gives place to insensibility; the muscles lose their reflex function and their reaction to electricity; the bladder and rectum become paralyzed. The invasion of the medulla by the disease, which is announced by paralysis of the muscles of the œsophagus and of the tongue, is a fatal complication. The pulse and the respiration become rapid and irregular from compression of the vagus, the temperature rises to 106° or 108° F., and death ensues through asphyxia or failure of the heart.
The course of acute spinal meningitis is rapid. It sometimes terminates fatally within two or three days, and the average duration of fatal cases is about a week, but exceptionally the disease may last for several weeks or even months. Even then complete recovery may take place, though permanent effects are usually left behind, such as paresis or paralysis of the lower extremities, muscular contractions, muscular atrophy, etc., from injury to the nerve-roots or the cord.