Myasthenia gravis / by Charles S. Myers.

  • Charles Samuel Myers
Date:
1902?]
Catalogue details

Licence: In copyright

Credit: Myasthenia gravis / by Charles S. Myers. Source: Wellcome Collection.

    13/46 page 315
    Sensory affections.—These were uncommon and, if present, usually in¬ significant. They are perhaps attributable in many cases to muscular weari¬ ness. Migraine accompanied the disease in four cases. Visual and auditory acuity was reduced in two cases. There may have been hysterical complica¬ tions in Burr and McCarthy’s case. Electrical reactions.—A diminished excitability of certain muscles to the faradic and galvanic currents was observed in four well-established cases of the disease ; but accurate galvanometrical experiments are still wanting. One case presented slight reactions of degeneration in a single muscle. Atrophy.—Save in this case (in which the peripheral nerves and muscles were not examined at the autopsy) no reaction of degeneration has been observed. In Dreschfeld’s (^) case, which lasted fifteen years, there was atrophy but no reaction of degeneration, and no degeneration noted after death. Of twenty-two fatal cases, completely studied, atrophy was expressly declared absent in the majority. Doubtless most of the few cases of Campbell and Bramwell’s list, where atrophy is recorded, were in reality either cases of poliomyelitis or neuritis, or cases where emaciation had been mistaken for degeneration. In Sossedorf’s case, however, the necropsy revealed atrophy and degeneration of the lingual muscles, while the hypoglossal nuclei and nerves were unaffected. Reflexes.—The patellar reflex was usually brisk; it was never absent. Clonus was absent. The arm reflexes were often absent. The plantar reflex was of the flexion type. The remarkable decrease of the knee jerk on repeated elicitation, observed by Strlimpell and others, is an exaggeration of what occurs in healthy persons; it was not obtained in all cases. Eye movements.—Paralysis of the intrinsic muscles of the eyes was not recorded in any of the twenty-two undoubted and completely studied cases of this disease. In two the pupils were of unequal size. In twelve there was partial or complete external ophthalmoplegia. In nine diplopia was observed, often a transient symptom. In fourteen of the twenty-two cases ptosis occurred; it is generally incomplete and is a most variable sign, one week present in one eye, the next week present in the other, in both, or in neither. It may be absent immediately after awakening from sleep, or during unusual emotional excitement. Jaws.—Paresis or palsy of the muscles of mastication was noticed in eighteen of the twenty-two cases. In the most severe cases, fatigue after biting is complained of. Occasionally early stiffness in, or loss of control over, these muscles has been recorded. The facial muscles.—Total facial palsy or paresis is uncommon; one or other of the three groups ^ generally escapes. The muscles of the face were affected in fourteen of the twenty-two cases. The most commonly observed defect was that the patient could no longer whistle or blow out a candle. Several of the patients could not tightly close their eyes. Implication of the frontalis was not usually noted; sometimes it contracted in order to com¬ pensate for the ptosis. In a few cases the face wore a peculiar mask-like expression; in one the naso-labial folds were exaggerated, in two others they were unequal, in a third they were obliterated. In one case the angles of the mouth were drawn downwards, in another outwards. Lagophthalmos was fairly common, but rarely well marked. The tongue.—In only nine of the twenty-two cases was paresis or palsy of the tongue noticed. The lingual muscles were less commonly involved than any of the other bulb-innervated muscles; in two of the above cases they were expressly declared intact before death. In Dreschfeld’s if) case the tongue had ^ According to Tooth and Turner the third nucleus supplies the frontalis and orbicularis oculi, the twelfth nucleus supplies the orbicularis oris, the palate, and the vocal cords.
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