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The case histories of two patients who had had a spinal cord injury (SCI) were selected by the senior author and sent to four experts in the ®eld of SCI. Based on the 1992 American Spinal Injury Association (ASIA) and International Medical Society of Paraplegia (IMSOP) standards, the four participants plus the senior author recorded the motor and sensory scores, the ASIA impairment scale (AIS), the neurological level (NL) and the zone of partial preservation (ZPP). Several minor scoring errors occurred among the participants, especially with motor scores when key muscles could not be tested due to pain, or external immobilization devices. Diculties with interpretation occurred with the motor levels and the ZPP for the patient with a complete injury. This exercise points to the need for all examiners of SCI patients to thoroughly familiarize themselves with the standards and to use the motor and sensory scores to arrive at a NL and ZPP. They also indicate a need to revise the standards to clarify the determination of sensory levels and how to score muscles whose strength is inhibited by pain.

SummaryThe locked-in syndrome (LIS) is a state of an upper motor neurone quadriplegia involving the cranial nerve pairs with usually a lateral gaze palsy, paralytic mutism, full consciousness and awareness by the patient of his environment. A his torical presentation of the LIS is given as well as a short description of the clinicoana tomic lesion causing LIS. The usual cause is vascular and corresponds to a pontine infarction due to an obstruction of the basilar artery but other lesions in the brain stem can also be the cause. Non-vascular aetiologies, especially traumatic, are reviewed. The use of electroencephalography (EEG), brain auditory evoked poten tials (BAEP) and somesthesic evoked potentials (SEP) are discussed as well as the use in the acute stage of computed tomography (CT), angiography, and magnetic resonance imagery (MR/). The last method may show well delineated ischaemic lesions some time after the event. The communication disability is probably the most difficult to overcome. Two cases of LIS are presented.

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THE combination of an easily distending lower motor neuron bladder and an atonic pelvic floor can result in a total impossibility, in certain cases, of voiding without surgical interference. In most cases, a single, or repeated T. U.R., of the bladder neck, is sufficient. However, if this, or these, should fail, the cause of retention must be found out, and in some cases, such procedures as an Y-V prostato-urethroplasty, or even electrostimulation, have been advocated to avoid a permanent indwelling catheter. In true L.M.N. lesions the missing contraction of the detrusor is replaced by abdominal strain, associated, or not, by 'Crede pressure'. This is sufficient as long as the internal sphincter is permeable. When this is not, the combination of backand down-tilting of the bladder base, and FIG. I Case report, Male, aged 45. Complete permanent flaccid paraplegia, below TI I on the right, LIon the left, due to communitive fracture of LI .