Le Coup de Poignard Rachidien: A Historical Perspective.

Nidal B Omar,Mark R Harrigan,Joseph Miller,R Shane Tubbs,Mohammadali M Shoja

doi:10.7759/cureus.4175

Abstract

A spinal subarachnoid hemorrhage (SAH) is uncommon. One of the earliest detailed analyses of a spinal SAH was in 1928 by the French physician Paul Michon, who coined the term “le coup de poignard rachidien” to describe the pathognomonic, intense spinal pain experienced by patients with spinal SAH, equating it to being stabbed by a dagger. Michon sub-classified spinal SAH into the upper and lower forms, pointing out that the stabbing spinal pain is more characteristic of SAH in the cervical and thoracic regions and especially in the interscapular region. Translation and subsequent analysis of Michon’s original French paper published in La Presse Medicale in 1928 shed light on two cases in which patients presented with le coup de poignard rachidien and signs of spinal cord dysfunction but little, if any, intracranial symptoms. The patients both showed symptomatic relief following therapeutic lumbar puncture. Later, authors have questioned the notion that intense spinal or interscapular pain is mandatory in the diagnosis of spinal SAH and have additionally provided evidence contrary to Michon’s assertion that intracranial symptoms, if any, occur later in the progression of spinal SAH and are largely insignificant.

Highlights

BackgroundA spinal subarachnoid hemorrhage (SAH) is a rare condition
Cases of spinal SAH had been described prior to Michon’s paper, and he cited many such works, he was the first to emphasize the acute and intense spinal pain, described as being “stabbed in the back by a dagger,” as part of the diagnostic criteria for certain types of spinal SAH [3]. His assertion was that many previous descriptions of spinal SAH were dubious because they were derived from autopsy cases in which the presence of both cranial and spinal blood made it difficult to determine the origin of the hemorrhage
We review Michon’s original work as well as more recent descriptions and the understanding of spinal SAH

Summary

Introduction

A spinal subarachnoid hemorrhage (SAH) is a rare condition. It is estimated that less than 1% of all cases of SAH are of spinal origin [1]. The patient was discharged on February 10 with neck stiffness, a mildly positive Kernig’s sign, brisk tendon reflexes in the lower extremities, and an intense but much more diffuse interscapular pain and headache. He returned for follow-up a week later and appeared to be in good health. Michon repeatedly made the assertion that le coup de poignard rachidien was part of the criteria for diagnosing spinal SAH, in the interscapular region He strongly downplayed the importance of cerebral symptoms and made no mention of any other than non-specific signs of increased CSF pressure. The imaging modalities available today have eliminated the need for diagnosis based on symptoms alone

Conclusions

Disclosures

Findings

Michon P