Diseases of the nervous system : a text-book of neurology and psychiatry / by Smith Ely Jelliffe and William A. White.
- Smith Ely Jelliffe
- Date:
- [1919]
Licence: Public Domain Mark
Credit: Diseases of the nervous system : a text-book of neurology and psychiatry / by Smith Ely Jelliffe and William A. White. Source: Wellcome Collection.
67/1050 page 59
![symptom complex. In addition to vasomotor and sweat anomalies, it is characterized by sinking in of the eyeball, narrowing of the lid slit (m. orbitalis), lowering of the upper lid and raising of the lower lid (m. tarsi), narrowing of the pupil (m. dilator pupillse) and reten¬ tion of the psychic and optic nerve reflexes of the pupil. In experimental section of the sympathetic the paralysis lasts only until the preganglionic part of the sympathetic chain again joins the preganglionic and the postganglionic the postganglionic. The contrast between the very active sphincter contraction and the equally sluggish relaxation is typical of sympathetic paralysis (Bumke). The localizing value for a diagnosis of sympathetic paralysis or irritation is self-evident. Both conditions indicate pressure upon the sympathetic chain due to a tumor, a traumatic lesion of the spinal cord (hematomyelia), or a tumor, degenerative process (gliosis) or an infective process in the upper dorsal segments of the spinal cord involving Budge’s center. More rarely a lesion of the oblongata (thrombosis of the posterior inferior cerebellar artery, syndrome of Babinski-Nageotte) or a lesion of the spinal roots in the cervicodorsal region (neuritis syndrome of Dejerine-Klumpke). The sympathetic lesion may be localized in its cervicodorsal, bulbar or basal parts according to the accompanying symptoms (disturbance of the hand muscles, tongue, deglutition apparatus, trigeminus). Pharmacological experiments with sympathicotropic substances during the last few years have added something to the differential diagnosis of sympathetic disease. For this cocaine and adrenalin mydriasis have been used. These tests can be easily performed provided there is a healthy uninjured, not inflamed conjunctival sac which is absorbing normally. Cocaine in a moderately strong solution (under 3 per cent.) stimu¬ lates the dilator. Absence of cocaine mydriasis indicates weakness of the sympathetic. If a paralysis has been shown by this method in the absence of other signs, it becomes necessary to discover the location of the lesion for prognostic and therapeutic reasons. Whether it be preganglionic or postganglionic, above or below the superior cervical ganglion and whether it be in a place accessible to the surgeon. The very active endogenous hormone, adrenalin, will settle this question. A 1 per cent, solution dropped into the conjunctival sac normally produces no reaction. (2 drops are dropped in every five minutes for three times [Cords].) If the irritability of the dilator be increased as is the case in postganglionic disease dilatation of the pupil will resuit after fifteen minutes. As Higier has shown, it is probable that after the nerve to the dilator is gone the contractile muscle tissue becomes more irritable. (Munk s isolation phenomenon, Langendorf’s paradoxical mydriasis.) I his adrenalin mydriasis is analogous to the rapid and maximal dilatation of the pupil after electrical, sensory or pyschic stimuli in animals in whom postganglionic section of the sympathetic has been experimentally secured.](https://iiif.wellcomecollection.org/image/b31352443_0067.jp2/full/800%2C/0/default.jpg)
