FLEMORRHAGE INTO THE SPINAL CORD In ffirmorrhage into the spinal cord, also, birth injuries are undoubt edly the most important etiologic factors. Schaeffer found extravasa tions of blood into the vertebral canal in 10 per cent of all his autopsies on newborn infants, and although these figures appear to me somewhat high, I can confirm the frequent occurrence of hamorrhage of this kind from. my own experience. The luemorrhages are often extraspinal, in which case they are found chiefly on the ventral surface of the lumbar portion of the cord. It is probable that the blood is not always the result of a local extravasation, but consists in part also of blood that has flown down from above after ffiemorrhage within the cranium and in the highest portions of the spinal column. Ifficmorrhages within the substance of the spinal marrow are extremely frequent in newborn infants. Such hamorrlaages are usually small and of no importance; their favorite seat is at the junction between the posterior and anterior horns. Gold scheider and Flatau's experiments on animals cominced them that fluids injected into the vascular sy.stem have a special tendency to escape at this point. Numerous small htemorrhages into the spinal cord are found especially in premature infants and in anencephalous monsters. Large htemorrhages into the spinal marrow may conceivably lead to cystic cw.ities, and the latter may bear some etiologic relationship to a later syringoniyelia (Schultze, Zappert and Pfeifer). Hxmorrhages have also been observed in the newborn Within the central canal; indeed parts of the canal are sometimes separated by the action of the haunorrhage.
The above conditions all represent more or less unexpected autopsy findings iu children who die soon after birth. General palsies in the newborn can be attributed to haunorrhage of the spinal cord only in very rare cases (Oppenbeim, Raymond).
All other causes play but a minor part in the etiology of spinal ffiemorrhage in the newborn. Traumatism is more apt to produce an
external injury than an isolated htemorrhage. In whooping-cough the sudden appearance of a spinal palsy during an attack naturally suggests the probability of hremorrhage into the spinal cord (Mauthner, Bern hardt and others), but we have no positive autopsy proof that such an accident occurs. Steffen reports a case hmmorrhage into the spinal cord after purpura.
In cases of this kind the diagnosis of spinal htemorrhage is based on the sudden appearance of symptoms such as have been described in connection with tumors of the spinal cord. Paraplegia, anmsthesia and sphincter paralysis are the most pronounced symptoms in the beginning; they rarely increase during the first few days and are more apt to dis appear in a. short time. There finally results a clinical picture which corresponds to that of a poliomyelitis, Brown-Sequard palsy, or trans verse myelitis. Pain is not common in central spinal Inemorrhages. In this stage localization of the spinal lesion is possible; but unless the history is very precise, the diagnosis of limmorrhage must always remain doubtful because the ultimate results of inflammation and tbose of hmmorrhage are clinically identical.
Unless the hamnorrhage proves immediately fatal (hmmorrhage in the upper portion of the cervical cord) the prognosis is not altogether unfavorable. But the improvement which at first takes. place usually does not go on beyond a certain point, after which one of the above mentioned permanent conditions develops.
In all cases of limmorrhage into the spinal cord the treatment consists in absolute rest, the application of ice bags, and the exhibition of styptics such as ergotin and gelatin. Catheterization must not be forgotten when there is paralysis of the bladder.