The Reflex Functions of the Completely Divided Spinal Cord in Man, Compared With Those Associated With Less Severe Lesions

Riddoch, George

doi:10.1093/brain/40.2-3.264

Cited by 196 publications

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“…The war afforded an unparallel opportunity to observe such cases, and Riddoch was able to study a group of eight patients with completely divided spinal cords (verified at operation) and show, contrary to Bastian's views, that reflex action as described by Sherrington was present in humans as well. 10 His meticulous studies on reflexes showed that the completely divided spinal cord passed through several stages, initially with an absence of tendon reflexes (spinal shock) but these returned at a later stage. 11,12 The reflexes were shown to be subject to the same rules as in animals.…”

Section: George Riddoch MD Frcp (1888-1947)mentioning

confidence: 99%

“…He described how: 'A bladder, which had never been distended or subjected to the ravage of septic infection, reacted reflexly as a rule to a larger amount of fluid than did a bladder whose musculature had been stretched by initial distension or by careless manipulation or had deteriorated owing to repeated attacks of cystitis.' 10 In an early description of autonomic dysreflexia, Riddoch described how sweating could be initiated by distension of the bladder, enemas, the coitus reflex or a change in position. 10 However, he did not mention suprapubic catheterisation or cystotomy.…”

Section: Bladder Managementmentioning

confidence: 99%

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George Riddoch: the man who found Ludwig Guttmann

Silver

Weiner

2011

Spinal Cord

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Section: George Riddoch MD Frcp (1888-1947)mentioning

confidence: 99%

Section: Bladder Managementmentioning

confidence: 99%

George Riddoch: the man who found Ludwig Guttmann

Silver

Weiner

2011

Spinal Cord

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“…The physiological implications are that the pathway can be activated by a supramaximal stimulus as shown when stimulating tendon re¯exes but that it is inactive to normal stimuli. This is borne out by Riddoch's work who, in 1917, 19 studied patients in spinal shock and showed that tendon re¯exes could be produced by increasing the force of stimuli. The clinical implications are that autonomic dysre¯exia can occur in spinal shock.…”

Section: Discussionmentioning

confidence: 99%

Early autonomic dysreflexia

Silver

2000

Spinal Cord

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Introduction: During the stage of spinal shock the conventional view is that autonomic activity is abolished. Here, evidence is presented that autonomic activity is still present. Patients: Four patients with acute cord transactions are presented: one new case and three from the literature. De®nitions: The de®nitions of spinal shock and autonomic dysre¯exia are given. Methods: All four cases showed acute autonomic dysre¯exia between 7 and 31 days after acute cord transection at a stage when the tendon re¯exes were abolished. Results: Two cases showed a severe rise in blood pressure; the two earlier cases, before blood pressure was routinely recorded, profuse sweating. In two cases autonomic dysre¯exia was obtained when the bladder was overdistended with 1000 ml and 1600 ml. In the other two cases it occurred in response to traumatic catheterisation. This was found when supramaximal stimuli were applied. It has not been recorded routinely as, with modern management, the bladder does not get overdistended or traumatised. Discussion: Other evidence, the blood pressure, and urethral tone is presented to show that sympathetic re¯ex activity of the cord is not abolished during spinal shock. Clinical signi®cance: The clinical importance of this is that autonomic dysre¯exia can be seen at an early stage and it should be considered in the di erential diagnosis of a sick patient immediately after spinal injury. Spinal Cord (2000) 38, 229 ± 233

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“…Animal studies have clearly shown faster recovery of tendon re¯exes in those with prior upper motoneuron lesions (eg motor cortex, vestibular nucleus or cord hemisection; 32 and absence of spinal shock is well known in patients with slowly progressive myelopathy. 11 Older patients, who sustain incomplete SCI, have a di erent clinical course and the majority do not ambulate as compared to a younger group of which 90% are ambulatory. 33 This di erence in clinical course may also be due to pre-existing damage to the cord in the older subjects, but the MRI studies were inconclusive.…”

Section: Discussionmentioning

confidence: 99%

“…Although he reported on only ®ve cases, there had been detailed descriptions of re¯ex recovery by Riddock 11 and Guillian 12 from World War I. The clinical ®ndings in these complete injuries were often con®rmed by evidence of cord transection at postmortem examination due to the high mortality 13 at this time.…”

Section: Introductionmentioning

confidence: 99%

The pattern of reflex recovery during spinal shock

et al. 1999

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Study Design: A prospective descriptive study of the course of recovery of re¯exes following acute spinal cord injury (SCI). Objectives: The purpose of the study was to observe the pattern of re¯ex recovery following acute SCI in order to determine the prognostic signi®cance of re¯exes for ambulation and their relationship to spinal shock. Setting: A regional spinal cord injury center in Philadelphia, Pennsylvania, USA. Methods: Fifty subjects admitted consecutively over a 9 month period and on the day of injury were observed for the following re¯exes; bulbo-cavernosis (BC), delayed plantar response (DPR), cremasteric (CRM), ankle jerk (AJ), knee jerk (KJ), and normal plantar response for 5 ± 7 days a week and 6 ± 8 weeks duration. The 50 subjects were assessed for ambulation of 200 feet at time of discharge. MRI studies were reviewed on 13/28 complete (ASIA A) injuries. Results: Thirty-®ve subjects (28 ASIA A, 4 ASIA B, 3 ASIA C) had a DPR of 2 days or longer duration and these subjects were not ambulatory. The fourteen subjects (12 ASIA D and 2 ASIA C), who were ambulatory, either had no DPR (11/14) or had a DPR of only 1 days duration (3/14). One subject (ASIA B) was not ambulatory and had a DRP of 1 days duration. The DPR was the ®rst re¯ex to recover most often, followed by the BC, CRM in the ®rst few days and later followed by the deep tendon re¯exes (AJ & KJ) by 1 ± 2 weeks respectively. Less than 8% of subjects had no re¯exes on the day of injury and the re¯exes did not follow a caudal-rostral pattern of recovery. Conclusions: Prognosis for ambulation based on re¯exes early after SCI should not be linked to current descriptions of spinal shock. In fact, the view of spinal shock, based on the absence of re¯exes and the recovery of re¯exes in a caudal to rostral sequence, is of limited clinical utility and should be discarded. The evolution of re¯exes over several days following injury may be more relevant to prognosis than the use of the term spinal shock and the presence or absence of re¯exes on the day of injury.

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The Reflex Functions of the Completely Divided Spinal Cord in Man, Compared With Those Associated With Less Severe Lesions

Cited by 196 publications

References 0 publications

George Riddoch: the man who found Ludwig Guttmann

George Riddoch: the man who found Ludwig Guttmann

Early autonomic dysreflexia

The pattern of reflex recovery during spinal shock

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