Michael S. Smith

A prospective study of physical trauma and multiple sclerosis.

During an eight year period 170 multiple sclerosis (MS) patients and 134 controls without physical impairment were followed closely to record all episodes of physical trauma and to measure their effect on exacerbation rate and progression of MS. There was a total of 1407 instances of trauma, which were sorted into various categories. Overall there was no significant correlation between all-traumas and disease activity. There was, however, a statistically significant negative correlation between traumatic episodes and exacerbations in 95 patients who had exacerbations during the programme, due primarily to less activity of the disease during a three month period following surgical procedures and fractures. Electrical injury had a significant positive association with exacerbation using a three month at-risk period, but there were no other significant positive correlations in any other category of trauma, including minor head injuries; there were no cases of head injury with prolonged unconsciousness. There was no linkage between the frequency of trauma and progression of disability. MS patients had two to three times more trauma than controls.

Trauma as an etiologic and aggravating factor in multiple sclerosis

We carried out a retrospective and prospective epidemiologic study designed to detect an association between trauma and multiple sclerosis in 130 patients and 82 age- and sex-matched controls. Electrical injury was followed by an increased frequency of exacerbation, which did not achieve statistical significance. There was no statistically significant association between other types of trauma and onset or deterioration of the disease. These findings do not prove that such an association cannot exist for any one individual patient; however, they do not provide evidence to support this idea.

Confusion, dysphasia, and asterixis following metrizamide myelography.

A patient exhibited confusion, dysphasia, and striking asterixis 18 hours after metrizamide myelography. The symptoms lasted for a day and a half. While metrizamide is a useful contrast medium, side effects are not unusual and can, on occasion, be quite severe.

Horner's Syndrome, An Unusual Manifestation of Multiple Sclerosis

From the Department of Neurology, Arizona Health Sciences Center, University of Arizona. It seems remarkable that multiple sclerosis does not commonly cause a Horners syndrome for this syndrome is a manifestation of many different disease processes which affect the caudal brainstem and cervical spinal cord, as does multiple sclerosis. Yet, a careful review of the literature detailing the clinical presentation of multiple sclerosis failed to reveal any mention of this syndrome.

Personal History Code Team

The last thing I wanted to do that Friday was an LP in the MICU. It had been a long, difficult day in the office, and I was tired from the previous night on call. I had already consulted on the patient and knew that, regardless of how the CSF cell count and chemistry came out, the outcome of her illness was not likely to be good. I wasn’t eager to do the procedure, but my personal rule was to do it whenever I started to argue with myself about why I shouldn’t. As I walked from my office over to the hospital, the shadows were long in the canyons on the front range of the Santa Catalina Mountains, and a gibbous Moon was well up in the southeast. It was going to be a nice night—for somebody. I wasn’t looking forward to another late evening at work. I referred to MICU as the place with “so much work and so little hope.” Patients in MICU were not immediately post-operative from lifesaving cardiac, neurologic, or trauma surgery. They hadn’t been saved in the cardiac catheterization laboratory by having stents placed into multiple vessels or by being injected with antithrombolytic drugs. The nurses in the other intensive care units mirrored their work: SICU nurses were confident, aggressive, with a “let’s do it” attitude. Many were men, and most of the hospital’s basketball team came from SICU staff. CICU nurses, nearly all women, were superb at understanding rhythm strips, conduction physiology, and cardiac drugs. MICU nurses were different—a tightly knit group, they were quietly competent. Despite their knowledge, however, they never tried to show me up, even when they easily could have. Maybe that is why I liked them so much. The unit often received end-stage patients from the other two units …

Personal History A wise owl

When I heard my father’s voice on the telephone, “Can you come up here?” I said to myself, “It’s finally happening.” I knew the day would come, but I had tried not to think about what I would go through when one of my parents started to fail. They had been in excellent health into their 80s, but no longer. My mother was seriously ill. I made plans to fly from Tucson to Oregon the next day to see what was going on and to help my father bring her home. For 25 years, I had lived near my parents, usually stopping by once a week for an hour or so. They had busy schedules, doing volunteer work, traveling, reading, and spending time with a large circle of friends. My relationship with my parents was mostly adult-to-adult, although from time to time I had to remind them that I was asking for neither their advice nor their approval but simply informing them of what I was doing. Every summer, they went to Oregon, took walks, crabbed, volunteered, and enjoyed being out of the desert heat. Two months before their last departure, my mother fell. Whether she had blacked out first and then fallen or was rendered unconscious by the fall was not clear. In any case, a cardiologist didn’t find anything significant, and I didn’t worry about the matter further. After all, I reasoned, these things happen to older people, even when they are one’s parents. A month after she arrived in Oregon, my mother fell again, breaking her hip. She had the hip pinned under general anesthesia and awoke delirious. Recovery was slow, according to my father. For the next 5 weeks, he told me that she was gradually getting better in the rehabilitation facility. It wasn’t until my …