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Biomedical subjects

R Gschaedler

Publications and source records attributed to R Gschaedler.

12 recordsLinked to original sources
PubMed1994

[Brown-Séquard syndrome after closed injury of the cervical spine].

The case of a Brown-Séquard syndrome at the C5 level, in a 21-year-old young man after a traffic accident is reported. Initially, the symptoms of spinal injury were concealed by those related to head and face trauma. The neurologic assessment showed a hemiplegia located in the same side as the medullar injury with a controlateral thermo-algesic anaesthesia. X-rays, CT-scan and MRI of the cervical spine confirmed the diagnosis. The treatment included the immobilization of the spine combined with i.v. methylprednisolone (bolus of 30 mg.kg-1 followed by a continuous infusion at a rate of 5 mg.kg-1.h-1 for 23 hours). The outcome was favourable. Six weeks later, the patient was again able to walk. However the thermo-algesic anaesthesia remained unchanged. This case report underlines the necessity of a careful and complete neurologic assessment of trauma patients and reminds of the possibility of occurrence of a Brown-Séquard syndrome in them.

Adult↗
PubMed1982

Clinical and anatomical observation of a patient with a complete lesion at C1 with maintenance of a normal blood pressure during 40 minutes after the accident.

The authors report on their clinical observations concerning a patient with a complete spinal cord injury at the level of C1, followed by a cardiac hypoxic arrest, due to immediate respiratory paralysis after the accident. Normal cardiac activity was obtained as a result of rapid resuscitation measures, using only intubation and external cardiac massage without any drug administration. The blood pressure was maintained without any drugs at a level of 130 Torr during 40 minutes before it fell to a permanent level of 50--40 Torr on ventilation alone. The diagnosis during the first hours was believed to be that of an irreversible coma with no evidence of vertebral injury. The patient started to recover consciousness after a few days but died on the 15th day. The case is discussed in the light of the literature and of the recent physiological experiments concerning the rapid changes of blood pressure after spinal cord section in animals.

Adolescent↗
PubMed1982

An unusual injury of the cervical spine caused by a fork lift.

A case of very unusual aetiology is reported. A severe traumatic injury of the cervical spine was associated with a suspended bilateral phrenic nerve paralysis, with limited sensory involvement, and weakness of the muscles of the right upper limb. The neurological status was otherwise normal, apart from slight weakness of the left upper limb. Artificial ventilation was necessary. Respiratory recovery was slow. The neural aetiology is discussed in relation to spinal cord and/or root involvement.

Accidents, Occupational↗
PubMed1979

Reflections on the intensive care of acute cervical spinal cord injuries in a general traumatology centre.

Fifty-one cases of cervical spinal cord injury were reviewed. The importance of the immediate comprehensive care after onset may be achieved successfully even in a General Traumatology Centre. The great majority of these patients were treated by orthopaedic methods as far as their vertebral injury was concerned. Mortality related to the spinal cord injury is 7.8 per cent. The methods used and our development are based on principles established by Sir Ludwig Guttmann; they have been shown to be durable and important.

Acute Disease↗
PubMed1978

Traumatic rupture of the aorta and paraplegia.

During the past 10 years, 15 traumatic ruptures of the aorta isthmus have been diagnosed. The most likely mechanism is that of a brutal deceleration. Three patients developed a complete mid-thoracic flaccid paraplegia. One died in a few hours of a complete rupture, the second after a few days from renal insufficiency, the third 12 days after, having been operated upon on the same day of the accident. All had associated lesions. Diagnosis can be very difficult in these patients, especially in the first few hours. Paraplegia is here considered as an aggravation ischaemic symptom with anuria and loss of blood circulation in the lower limbs. In delayed cases the vascular mechanism of the infarction of the spinal cord is discussed, either by compression of the intercostal arteries or by direct compression of the aorta itself. In our cases, the most likely mechanism is that of an obstruction of the lumen of the aorta by a torn inner coat. These patients must be transferred as quickly as possible to a cardiovascular surgical unit and operated upon immediately. Three cases of preoperative, rapidly progressive paraplegia with neurological recovery after the operation, have been reported in the literature.

Accidents, Traffic↗
PubMedDate not supplied

Reflections on the intensive care of 106 acute cervical spinal cord injury patients in the resuscitation unit of a general traumatology centre.

This presentation deals with an 11 year survey of 106 cervical spinal cord injuries, admitted immediately after injury or during the very acute phase, to the Traumatology Resuscitation Unit of Colmar, (France). A preliminary report concerning 51 patients was published in 1979. The follow-up study concerns a further 55 cervical spinal cord injured patients admitted from January 1979 to December 1984. The emphasis of our presentation concerns the frequency of some of the main complications and their attempted prevention: the haemodynamic disturbances caused by over-hydration; the prevention of haemorrhagic stress ulcers is not only by the use of specific drugs, but mainly by immediate intravenous adequate caloric nutrition. This can be associated with, or followed as soon as possible by, an adapted caloric diet, possibly by a naso-gastric tube. For serious respiratory complications, artificial ventilation even for long periods as discussed, by nasal intubation or in some patients tracheotomy.

Adolescent↗