Causes of death in the early and late stages of paraplegia

Abstract

An analysis of 150 cases of paraplegia coming to post-mortem at Stoke Mandeville Hospital between 1945 and 1962 has been made to ascertain the major causes of death. Twenty-eight cases died within two months of paraplegia. Respiratory failure in cervical lesions and pulmonary embolism in non-cervical lesions were the most important causes of death related to paraplegia in this group. One hundred and twenty-two cases died in the late stages of paraplegia. Renal failure was the major cause of death in three-quarters of the 84 chronic paraplegics who died from causes related to their paraplegia. The renal failure was due to a mixture of three pathologies-chronic pyelonephritis, amyloidosis and hypertension. These all result from the two main complications of paraplegia namely, pressure sores and urinary sepsis. There was a much higher incidence of amyloidosis and hypertension associated with chronic pyelonephritis in our series than reported by other writers. The reasons for this are discussed. Although the pattern of disease in paraplegics is changing, urinary infection with all its sequelae remains the major underlying cause of mortality in chronic paraplegia. © 1963, International Spinal Cord Society. All rights reserved.