Shell-shock: Brown-Séquard syndrome, hematomyelic?
Case 396. (Ballet, August, 1915.)
A soldier, 24, went to the front November 12, 1914, and June 1, 1915, had a shell burst near him in the trench, on the occasion of which he felt a violent shock, as if a blow in the kidneys. He felt suddenly paralyzed in both legs. He was crouching at the time of the shell burst. His legs felt dead, and he had such violent pain in the thorax as to make breathing difficult. He was carried to a shelter. After a few hours, the left leg began to move again.
He was carried to the ambulance, remaining there five days, unable to walk, though able to move and turn in bed, slightly constipated, with persistent pains in back. He was then carried to Auxiliary Hospital 231, at Paris, and a bullet (!) was found superficially lodged in the region of the left scapula. Neither patient nor physicians had hitherto observed the bullet, which could have had nothing to do with any spinal lesion.
The pains, in the course of a month, grew less, and at the end of two or three weeks he began to walk and was sent to the psychoneurosis service at Ville-Évrard, July 10. He then complained of pain in the right thorax, especially on movement or after sitting up some time. He could hardly bring himself to the sitting posture from the bed, and found difficulty in raising the right leg therefrom. In walking, the right leg was dragged behind. The reflexes were increased on the right side. There was ankle clonus without Babinski sign. Anesthesia to touch over the whole of the left leg. Anesthesia to pin prick and temperature as far as the umbilicus. Cold was not felt on the left side.
The water of a bath seemed lukewarm on the left side and warm on the right. The left side of the scrotum and the left half of the penis showed the same disorder of sensibility. There was a zone of hypesthesia on the right side of the thorax in the region of the lower ribs. The patient compared his sensations while at rest and without contact to a sensation of painful pressure occurring intermittently, or rather in paroxysms, not advancing beyond the median line of the back. Here was a question of Brown-Séquard syndrome, probably due to a slight hematomyelia, but associated with no external lesion or any injury to the vertebral column.
Re Brown-Séquard’s syndrome, see Athanassio-Benisty with respect to spinal cord symptoms associated with lesions of the brachial plexus. It appears that the combination of spinal cord and brachial plexus injury is not uncommon. Note in this case that a bullet was found in the left scapula region. According to Ballet, this bullet could have had nothing to do with a spinal lesion.