As  a  rule,  in  spinal  hemorrhage,  the  cerebral  functions  are  unaffected ;  the
unfortunate  patient  is  conscious  of  all  his  sufferings  from  first  to  last.  Occa-
sionally, however,  consciousness  is  lost  for  a  short  time,  apparently  from
shock,  and  even  delirium  or  coma  may  come  on,  either  as  indirect  effect  of
the  spinal  lesion  on  the  brain,  or  in  consequence  of  a  sudden  increase  in  the
intra-cranial  pressure,  due  to  the  displacement  upward  of  the  spinal  fluid  by
the  effusion  of  blood.  But  in  most  cases  in  which  cerebral  symptoms  co-
exist with  those  of  spinal  hemorrhage,  the  former  have  been  due  to  simul-
taneous intra-cranial  disease.  So,  in  some  cases  of  spinal  hemorrhage  in
newly-born  children,  apoplectiform  symptoms  have  been  present  from  simul-
taneous hemorrhage  into  the  membranes  of  the  brain.  In  very  rare  cases
the  symptoms  of  spinal  hemorrhage  have  come  on  insidiously,  without  pain,
as  in  a  case  in  which  extensive  hemorrhage  outside  the  dura  mater  in  the
cervical  and  upper  dorsal  region,  in  a  girl  of  fourteen,  caused  only  very
gradual  weakness  in  the  arms,  and  difficulty  of  breathing,  from  which  she
died  at  the  end  of  a  fortnight.  *

The  symptoms  in  acute  cases  usually  reach  their  height  in  two  or  three
hours,  sometimes  not  for  a  few  days.  Death  may  occur  when  the  symptoms
are  fully  developed,  or,  after  reaching  their  height,  they  may  decline,  to  be
increased,  a  day  or  two  later,  by  secondary  meningitis.  This  is  accompanied
by  some  pyrexia  and  lasts  a  week  or  ten  days,  and  then,  in  favorable  cases,
permanent  improvement  commences.  It  is,  however,  very  common  for  death
to  take  place  when  the  symptoms  have  existed  a  few  hours  only.  It  may  be
due  to  exhaustion,  in  consequence  of  the  violence  of  the  pain  and  spasm,  but
is  more  often  produced  by  interference  with  respiration.
