[Brachial diplegia of traumatic origin as a result of injuries of the cervical cord].

Described by Dide and Lhermitte (1917) the brachial diplegia or bilateral paralysis of the upper limbs, is called since Schneider's data acute central spinal cord injury (1956). It is characterized by disproportionately more motor impairment of the upper than of the lower limbs, bladder dysfunction and variable sensory loss (pain and temperature) below the level of the cervical injury. For Richard C. Schneider the mechanism is a severe hyperextension injury and the anatomical finding indicate a central cord destruction with bleeding and hematomyelia. The pattern of the recovery is first return of the motor power in lower extremities; then bladder function and finally strength in the upper extremities reappears (finer finger movements coming back last). In our experience (28 cases) the incidence of the brachial diplegia is 20% of the cervical spinal cord injury and 31% of the incomplete cord lesions. The average age is 54 years. In the half of our cases hyperextension is the responsible mechanism and hyperflexion is present in one third of patients. Radiological findings indicate some vertebral displacement in 40% of cases and no patent loss of the bodies alignment in 28% of patients. Clinical investigations authorize the description of 4 clinical patterns: 1--Incomplete tetraplegia with more motor impairment of the upper extremities (57%), 2--Brachial diplegia (without loss of function of the lower limbs) 25%, 3--Brachial diparesis with total recovery (11%), 4--Incomplete cord lesions with Brown Sequard syndrome and brachial diplegia (7%). The review of the literature (Bohlman, Barraquer) and our anatomical findings show that central hematomyelia is not constant.(ABSTRACT TRUNCATED AT 250 WORDS)