HEMORRHAGES INTO THE SPINAE MEMBRANES. 



Meningeai, vSpinal Apoplexy. H.-5;matorrachis. 2. Hemor- 

 rhage INTO THE Spinal Cord. Spinal Apoplexy. 



H^M ATOM YELI A . 



Definition. Causes: violent exertion, blows, falls, morbid blood, fract- 

 ures, caries, tumors, tubercle, aneurisms. Lesions : Clot between or outside 

 membranes in meningeal haemorrhage, in gray matter and even in white in 

 myelon bleeding. Cord bulges. If survives, nervous matter absorbed. 

 Symptoms : Sudden stiffness or palsy of given areas ; spasms more common 

 in meningeal extravasation. Rapid muscular wasting. No fever at first. 

 Treatment : cold to part ; slings ; atropia, ergot, lead acetate. Later as 

 for myelitis. Large clot may warrant surgical interference. 



In tlie first of these forms the bleeding takes place between the 

 arachnoid and the two contiguous membranes — pia and dura, or 

 outside the dura. In the second it takes place into the substance 

 of the cord though it may encroach on the pia mater. Both con- 

 ditions have been attributed to violent mu.scular efforts or con- 

 tractions as in draught, racing, fighting, leaping, tetanic con- 

 vulsions, al.so to blows on the back, or falls from a height. Mor- 

 bid states of the blood in which there is a hemorrhagic tendency 

 (scurvy, purpura, haemophilia, anthrax) may be contributory 

 caitses. Spinal fractures, aneurisms, caries, tumors, and tubercle 

 may be additional causes. 



Lesions. In meningeal bleeding the clot is found outside the 

 dura, or between the dura and arachnoid which may or may not 

 be ruptured. A clot on the pia mater may press seriously on the 

 cord or may cause rupture of the arachnoid. In hemorrhage 

 of the cord, the effusion usually begins in the gray matter, 

 though it may extend far into the white. It may be circumscribed 

 to half an inch in diameter or affect almost the entire length of 

 the cord. The cord may be distinctly enlarged at the point of 

 effusion, and in exceptional cases the blood may have broken 

 through to the membranes. If the patient survives, absorption 

 and degenerations of the cord are inevitable. 



Symptoms. In both forms there is a sudden attack, with 



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