Spinal arachnoiditis in Jamaica

Ten cases of spinal arachnoiditis with either complete or partial myelographic block are presented. The importance of surgical exploration in all these cases is emphasized. The difficulty of recognizing spinal arachnoiditis at operation and the value of corticosteroid therapy in these patients are discussed (AU)

The clinical features and aetiology of the neuropathic syndrome in Jamaica

The clinical and laboratory findings in 125 patients with the neuropathic syndrome are described. Certain new clinical features such as the presence of a positive jaw jerk, spinothalamic changes, pupillary changes, have been noted and further details on established physical signs have come to light. Investigations emphasize the high percentage of positive tests for treponemal infection among the group and the combination of the physical signs and above tests is used as the basis for discussion in suppport of a syphilitic aetiology. Some patients, however, do not have clear cut evidence and this group has to be asssessed critically to determine other possible aetiological factors (AU)

Neuropathies in Jamaica: a clinical and laboratory study of the aetiology of certain neurological syndromes in Jamaica with particular reference to the role of syphilis in the Jamaican Neuropathies

The characteristics of the neuropathic syndrome seen in Jamaican patients are described, and the relevant literature is reviewed in Section I. This syndrome differs from that seen in prisoners of war in that there is no clinical evidence of vitamin deficiency and spastic syndromes predominate. It differs from similar syndromes described in West Africa because of the high rate of positive tests for treponemal infection and the high incidence of spasticity. The evidence in favour of the various possible aetiological factors is examined critically and it is concluded that malnutrition, syphilis, yaws, viral and bacterial infections, bush teas, arsenical sprays and malaria are all possible causative agents. An attempt was therefore made to assess the relative importance of each. Of the patients examined, 125 fulfilled the criteria for the neuropathic syndrome. These patients were examined at least twice by me and particular attention was paid to features bearing a causal relationship to the aetiological factors mentioned above. The system of examination, the laboratory methods used, and the manner of presentation of results are described in Section II. The results are presented in Section III, and their significance is discussed in Section IV. Little evidence was found to indicate that malnutrition, toxins, and bacterial or parasitic infections were important factors in the aetiology. However, a considerable amount of evidence, direct and indirect, was accumulated to suggest that syphilis is the predominant aetiological factor in the neuropathic syndrome in Jamaican patients. Conclusions concerning the aetiology, course and treatment of this syndrome are summarised in Section V (AU)

Spinal arachnoiditis

The pathology of spinal arachnoiditis is described. The clinical features of twenty patients are presented. The aetiology is discussed. Initial treatment should be with corticosteroids particularly in early cases. If there is doubt laminectomy should be carried out to exclude a tumour (AU)