Nervous and mental diseases . at a reason- 366 DISEASES OF THE CORD PROPER. able level. The danger arises from extension of the myelitis and fromcomplications arising through cystitis, bedsore, nephritis, and septicemia,or concurrent acute infections, such as pneumonia. Course.—Acute cases reach their maximum in a few days, othersin a few weeks, and then, if death does not result, a long stationaryperiod or one of gradual improvement or decline succeeds. The occur-rence of an extension of the inflammation may, at any time, jeopardizelife by invading the respiratory apparatus. Acute bedsore is
Nervous and mental diseases . at a reason- 366 DISEASES OF THE CORD PROPER. able level. The danger arises from extension of the myelitis and fromcomplications arising through cystitis, bedsore, nephritis, and septicemia,or concurrent acute infections, such as pneumonia. Course.—Acute cases reach their maximum in a few days, othersin a few weeks, and then, if death does not result, a long stationaryperiod or one of gradual improvement or decline succeeds. The occur-rence of an extension of the inflammation may, at any time, jeopardizelife by invading the respiratory apparatus. Acute bedsore is always adangerous complication, and cystitis is hardly less so. When spasticfeatures develop, they rarely recede to any considerable extent, and implypermanent disability and the paraplegic state. Sensation or motion mayreturn singly. The localized wasting due to involvement of the anteriorgray never repairs, and adjacent portions of the gray matter may subse-quently be involved. Death may take place early from cardiac and. i Fig. 131.—Dystrophic bedsores over trochanters and sacrum in a case of transverse myelitis. respiratory failure or follow at any period from exhaustion due to theprimary infection or that secondary to bedsore, cystitis, nephritis, septi-cemia, or is caused by a gradual extinction of the vital energy. The casesthat recover bear the indelible marks of the disease in weakened andspastic legs, areas of anesthesia, sphincteric paresis, and local atrophiesvariously distributed in accordance with the seat, extent, and intensityof the cord-injury. These furnish cases of so-called chronic myelitis,but inflammation has subsided and the conditions presented are due tothe degenerations that follow the primary lesion. They are more fullydescribed under the head of The Paraplegic State. Diagnosis in myelitis presents numerous problems and requirespainstaking examination and study. We have to ask ourselves : (1)Whether the cord is actually diseased ; (2) the extent o
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