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An eponymous reaction to a knife wound
  1. D Blackburn1,
  2. D J Werring1,
  3. S E J Connor2,
  4. N Munro1,
  5. N P S Bajaj1
  1. 1Department of Neurology, King's College Hospital, London, UK
  2. 2Department of Neuroradiology
  1. Correspondence to:
 Dr N P S Bajaj, Department of Neurology, King's College Hospital, Mapother House, De Crespigny Park, Camberwell, London SE5 8AF, UK;
 spgtnpb{at}iop.kcl.ac.uk

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Answers on p 379.

A 27 year old man was admitted to casualty having been stabbed in the back at a nightclub. He had taken an ecstasy tablet and had consumed some alcohol. On assessment, he was alert and cooperative with a 2 cm long, visible knife wound on the right hand side of the thoracic vertebral column. Examination of the cardiovascular, respiratory, and gastrointestinal systems was normal.

Neurological examination revealed no abnormality of cranial nerves or upper limbs. Lower limb examination revealed normal right leg tone, power, and reflexes. Left leg tone was spastic with clonus and pyramidal weakness. The left knee and ankle jerks were pathologically brisk and he had an up-going left plantar. The right plantar was flexor. Light touch was normal on the right and abnormal on his left leg up to a soft level at D8. He could not detect temperature or pinprick in his right leg up to D10. Vibration sense was absent bilaterally up to the anterior superior iliac spines. Joint position sense was absent bilaterally at the toes and the ankles. The left lower abdominal reflex was absent with all other abdominal reflexes being normal. Anal tone was normal. The next day he developed a severe frontal headache that prevented him from sitting him up in bed. There was accompanying nausea without visual aura or photophobia.

QUESTIONS

  1. Where is the anatomical site of injury and which spinal tracts have been damaged?

  2. What is the name of this syndrome?

  3. Give three other causes of this syndrome.

  4. What is the cause of his headache?

  5. How would you treat his headache if the symptoms persisted?

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