I desire to present a few observations on the significance of the variations in the character of the onset of certain forms of spinal paralysis, for I believe that in some instances the nature of the pathologic conditions present may be determined by the mode of onset alone.
Extramedullary spinal tumors are generally found to be either fibromas or endotheliomas. They grow slowly, producing gradually a weakess of the limbs that increases progressively. Spinal thrombosis, on the other hand, is marked by a sudden or apoplectiform onset; it is not a rare condition, and is usually caused by syphilitic arteritis of one or more of the blood vessels of the spinal cord. The sudden onset of spinal paralysis, however, has also been regarded as indicative of hemorrhage within the cord; but spontaneous hemorrhage, or hematomyelia without trauma, is so exceedingly rare as to render its occurrence most doubtful, for it