Abstract. In a study of 145 patients with severe cervical spine injury, it was found that 79 had serious neurological disturbance. A policy of the earliest possible referral to a spinal paralysis service is recommended. Associated injuries and in particular a head injury can make early precise neurological diagnosis difficult, and may affect management of the spinal injury. The use of Gardner Wells Skull Tongs and the Edinburgh Simpson Bed is recommended. Early spinal operation does not influence outcome of neurological function. Anatomical re-alignment of the spine is not essential for neurological recovery. Myelography is very rarely of benefit in assisting diagnosis and treatment. Glucocorti costeroids and Mannitol do not appear to influence neurological recovery.The prognosis in relation to clinical neurological syndromes is discussed.
SUMMARY Factor VIII R:Ag was measured serially in 42 patients who had intracranial haemorrhage. It was found that the factor decreased or remained static in the 24 patients who improved (p < 0O025), while it increased in the 18 who died (p < 0 0005). It is suggested that this factor can be used as a prognostic parameter to predict the outcome after intracranial haemorrhage.Factor VIII circulates in the plasma as a complex composed of two components: factor VIII:C, which has the clotting activity, and factor VIII R:Ag, or von Willebrand's Factor, which is responsible for platelet adhesiveness to subendothelium.' Factor VIII R:Ag is synthesised mainly by endothelial cells and megakaryocytes.2-5 It is released from endothelial cells into the blood stream in response to certain stimuli, such as venous occlusion, exercise, infusion of adrenaline, nicotinic acid, vasopressin and 1-deamino-8-D arginine vasopressin (DDAVP).67 A rise in factor VIII R:Ag level is noticed after pneumoencephalography and electro-shock which is not blocked by beta blockers.8 9 It is also seen in glomerulonephritis, pre-eclampsia and in limb ischaemia in diabetes. o Since all parameters used to assess the prognosis in intracranial haemorrhage are either clinical or radiological, " and since there are no chemically measurable substances to achieve this, we decided to study the value of factor VIII R:Ag in this respect. The aim was to determine the changes of factor VIII R:Ag in cases of intracranial haemorrhage and to study prospectively whether it can be used as a prognostic factor in the determination of the outcome in patients afflected with such haemorrhage, and to do so as early as possible in the course of the disease.
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