Ethical questions in the treatment of spinal cord injured patients.

Modern medicine has greatly benefitted spinal cord injured patients. The daily process of their rehabilitation, however, creates serious ethical problems, which the clinician attempts to solve using a humanistic, multidisciplinary and interdisciplinary approach. We present some of those conflicts, especially those caused by the survival of totally dependent patients and those related to our communication with the patient and his family.

The brain injured patient, some poetic and neurologic aspects.

In this short "anthology," the various neurologic and neuropsychologic aspects of brain injury are illustrated by quotations from the Bible, literature, poetry, and history. The close connection between poetry, literature and neurology is proved again.

Traumatic cerebral flaccid paraplegia.

Two cases of paraplegia caused by head injuries sustained in recent military conflicts are presented. The underlying pathological disturbances could be related to the CT scan appearances and are discussed in the light of previously reported series. Both cases were remarkable for an early and prolonged paraplegia which was flaccid, rather than spastic, and for the sensory impairment produced.

Rehabilitation after spinal cord injuries complicated by previous lesions.

Since Sir Ludwig Guttmann introduced the comprehensive modern clinical approach to the rehabilitation of spinal cord injured patients much experience has been accumulated. Modern spinal cord injuries centres have opened throughout the world, treating mainly acute spinal cord injuries in young patients. At Stoke Mandeville Hospital we have had the opportunity to treat several spinal patients who had suffered previous neurological or orthopaedic disorders.

Acute spinal cord injuries in the Lebanon War, 1982.

Our experience with 17 patients with spinal cord injuries (SCI) acquired in the Lebanon War, 1982, is described. The SCI were due to gunshot wounds in 12 patients and to other causes in 5. Two laparotomies and one thoracotomy were performed.

Peculiar septic responses in traumatic tetraplegic patients.

Patients with a high level tetraplegia from a spinal injury have only been able to survive the critical initial period since the development of modern resuscitation techniques including artificial respiration. However, their lives are still threatened by many complications, such as decubitis ulcers, infections and respiratory failure. We describe four young tetraplegic patients who developed an unusual sepsis pattern several years after the injury.