Edwin Smith Papyrus Case 8: a reappraisal

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Jeremy C. Ganz M.A., Ph.D., F.R.C.S.
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  • Ulverston, United Kingdom
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There are 3 translations of the Edwin Smith Papyrus: Breasted's (1930), Allen's (2005), and Sanchez and Meltzer's (2012). Case 8 is similarly presented in all 3 translations, although with increasing detail in the later works. The patient in Case 8 had a comminuted skull fracture under intact skin. There were palpable pulsations at the fracture site. There was deviation of the eye on the side of the injury and an ipsilateral spastic hemiparesis in an ambulant patient with bleeding from the nose and ear.

Explanations of the paralysis have included a contrecoup lesion and compression of the contralateral cerebral peduncle against the tentorial incisura. Brainstem compression due to herniation is accompanied by loss of consciousness. Extensive contrecoup lesions consistent with the extent of the described paresis would also be associated with probable coma. The paralysis was spastic, but spasticity takes weeks to develop after trauma. Yet this patient's trauma was fresh, as there was still bleeding from the nose and the ear.

It is suggested the paresis antedated the trauma, which was not its cause. The reasons for this suggestion are presented in this paper.

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Contributor Notes

Address correspondence to: Jeremy C. Ganz, M.A., Ph.D., F.R.C.S., 53 Market St., Ulverston, Cumbria LA12 7LT, United Kingdom. email: jcganz@gmail.com.

Please include this information when citing this paper: published online January 31, 2014; DOI: 10.3171/2013.12.JNS131520.

  • 1

    Allen JP: The Edwin Smith Papyrus. The Art of Medicine in Ancient Egypt New Haven, CT, Yale University Press, 2005. 79

  • 2

    Breasted JH: The Edwin Smith Surgical Papyrus Chicago, The University of Chicago Press, 1930

  • 3

    Sanchez GM, & Meltzer E: The Edwin Smith Papyrus: Updated Translation of the Trauma Treatise and Modern Medical Commentaries Atlanta, Lockwood Press, 2012

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  • 4

    Wissel J, , Schelosky LD, , Scott J, , Christe W, , Faiss JH, & Mueller J: Early development of spasticity following stroke: a prospective, observational trial. J Neurol 257:10671072, 2010

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