A treatise on common forms of functional nervous diseases / by L. Putzel.

  • Putzel, L. (Leopold), 1855-1942
Date:
1880
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Licence: Public Domain Mark

Credit: A treatise on common forms of functional nervous diseases / by L. Putzel. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

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    Very few opportunities liave been afforded for investigating the path- ological anatomy of this affection, and I have only been able to obtain re- cords of five post-mortems upon patients suffering from athetosis. In one, the brain was found normal; in the second, two small spots of softening were discovered in the first temporal convolution; in the third case, the patient also suffered from dementia paralytica, and the brain presented no evidences of a localized lesion; in the fourth case, the athetosis occurred as a complication of locomotor ataxia, and a small spot of softening was found at the posterior, inferior, and outer extremity of the right lenti- cular nucleus. There was probably, however, no connection between this lesion and the athetosis, since the latter occurred upon both sides of the bod}-. The fifth case is of great interest with regard to the light thrown upon the relations of the affection to post-hemiplegic chorea, and I shall, therefore, present a short abstract of the case as reported by Dr. Sturges.* Case VIL—H. B , aet. 33 years; when three years old. the patient had whooping-cough, and shortly afterward had two fits, which left him paralyzed on the left side. He gradually gained power, however, in the limb, and, at the age of ten could run about as well as other boys. The athetosis appeared soon after the fits, and gradually increased in severity as the muscular power was restored. The movements were almost exclusively confined to the left upper limb, and were continuous and involuntary. When the hand was ex- tended with the palm downward, the index and middle fingers were slowly and gradually flexed. The thumb was also adducted, the hand was then supinated, the fingers again extended, and the thumb abducted; prona- tion of the hand com]Dleted the cycle. The patient could slightly control the movements by a great effort of the will; the hand was only quiet during sleep. The left leg occasionally exhibited a somewhat similar condition, but only when the patient was tired out after a long walk. Death occurred from diarrhoea and exhaustion. Autojysy.—Brain: right hemisphere distinctly smaller than the left; the posterior half of the middle and inferior frontal convolutions, and, to a slighter extent, the superior and ascending frontal were distinctly smaller on the right side than on the left; the parietal convolutions were also smaller on the right side. There was a depression on the anterior portion of the temporo-sphenoidal lobe, about one inch long; there was also a deep depression extending backward into the lobe, about three- fourths of an inch deep. A deep excavation was found between the anterior extremity of the perforated spot and the convolutions of the island of Reil, extending backward to the level of the corpora albicantia and forward to the anterior surface of the hemisphere. The sides of the fissure seemed to have been in apposition, except outside the perforated spot, where the cavity was about one-fourth inch wide; its roof was formed by radiating fibres spreading upward from the pons. Upon opening the ventricles, almost the whole of that portion of the rig-ht corpus striatum lying in front of the thalamus appeared to be destroyed; the posterior portion of the nucleus caudatus was unaffected. A small portion of the inner part of the corpus striatum near the middle appeared intact, but the whole of the gray substance was destroyed. The optic thalamus seemed to be quite healthy, * Lancet, March 15, 1879.