The symptom-complex of the acute posterior poliomyelitis of the geniculate, auditory, glossopharyngeal and pneumogastric ganglia / J. Ramsay Hunt.

  • Hunt, James Ramsay, 1872-1937.
Date:
1910
Catalogue details

Licence: In copyright

Credit: The symptom-complex of the acute posterior poliomyelitis of the geniculate, auditory, glossopharyngeal and pneumogastric ganglia / J. Ramsay Hunt. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    As is well known, jiaralytic complications may occur in other parts of tlie body in zona; notably of the ocular nerves, but also in the distribution of the spinal nerves. These are, comparatively speaking, rare, probably because the inflammatory lesions are limited by the capsule of the ganglion, and in ordei' to reach the motor nerves of the eye in Gasserian involvement, or the anterior root in that of the spinal ganglia, the inflam- mation must first l)rcak through this fibrous wall, or travel for some distance along the course of the sensory nerve. The capsule of the ganglion, therefore, forms a natural barrier and protection against the extension of the inliammatory process. Anatomical conditions are different, however, iii the ganglia under consideration. Here the fibers of the seventh, eighth, ninth and tenth nerves are in more immediate relation to the cell structures of their respective ganglia, and are not separated by an intervening fibrous wall. For this reason very slight inflammatory reactions within these ganglia Jeopardize their respective nerve fibers. This intimate associa- tion of ganglionic structure and nerve fibers would account, not only for those cases with light and transient symptoms, hut also for those of a more severe grade, with lasting ini])airment of function. In my study of this group of cases, I have encountered none in which a fatal issue could Ije attributed directly to the disease itself. It is well known that a unilateral lesion or section of the vagus is not necessarily dangerous to life; and as herpes zoster is usually unilateral pneumo- gastric involvement on one side would not he fatal. If, however, bila- teral zona of the cephalic extiemity should occur, involving the ganglia of the pneumogastric nerves on both sides dangerous symptoms, or even a fatal termination rrright result. It is perhaps significant in this con- nection to recall the wide-spread belief among the laity of the fatal ten- deircy of bilateral shingles. Possibly we have here an explanation for a tradition which is common to all nations. I would also emphasize the fact that in rny study of this subject, I have found no cases with facial, auditory glossopharyngeal or pneumo- gastric nerve complications, accompanying an eruption of herpes zoster, cxceitt when situated on the cephalic extremity of the body; i. e., herpes facialis, oticus, pharyngis, laryngis lingualis, and occipitocollaris. That such neural complications do not accompany an eruption in the lower segments of the body is readily understood from the tendency of the posterior poliomyelitis to limit itself to a small series of ganglia, usually only one or two. In severe forms of infection, however, with extensive involvement of the cerebrospinal chain of ganglia there is no reason, theoretically, why cranial nerve palsies may not occur.
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