Nine cases of Graves' disease: ophthalmoplegia : remarks on the lid-symptoms / by Arthur Maude.

  • Maude, Arthur.
Date:
[1892?]
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Licence: Public Domain Mark

Credit: Nine cases of Graves' disease: ophthalmoplegia : remarks on the lid-symptoms / by Arthur Maude. Source: Wellcome Collection.

Provider: This material has been provided by UCL Library Services. The original may be consulted at UCL (University College London)

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    ])eimniien(. weakness of tlie third uerve, and also of the superior iirancli oCtlie fioinl. When tliis patient stares vohititariiy, i.e., when nhe forces llie third nerve to act, tliere is retraction of the lid. In h(>r cMse there is great irregiilarity in tlie occnrrence of the symptoms, ;ind the irregnlarity is very marked in all cases if they nre wnlciied frequently. I have taken observations at freqnent interviews of eight cases, and Hiul:—- Case. Grafe'a Sign. Stelhvag's Sign. On« (friiste) . . . Abseut Absent. OuB (developed) )) » Two „ . . Present Oue „ . . Present with ptosis Appeared when ptosis subsided. T«o „ . . Never preaeut Always marked. One „ . . Always ocou rred together. Thu^e (liscrep;nicies in evidence 1 attribnle to the fact that the symptoms nre due to a disturbed balance between two sets of nuiscles snp[)lied by three nerves, two of which are under the control of llie will, and the third involiuitary. The irritability of tire.se mll^cles mnst vary in different individnals and at different times in tiie same individual, and it is impossible absolutely to eliminate the factor of the will from a patient under stndy. The second case on 1 he above list who has never had any lid-symptoms has for some weeks shown oedema of the cheeks and lower eye- lids, and tliis wonid appear to oppose the remarks I made above on the cansat ion of this oedema. But she has also much swelling of the feet, and (she asserts, though I have never seen it) some cedema of the hands. The solution of this is that cedema of the lower lids in Graves' disease is not due simply to a paralysed orbicularis, for we do not get facial cedema in ordinary facial paralysis, but that it is caused by the paresis coupled with a vaso-motor disturbance which produces the oedema elsewhere.- High authorities^ have ascribed the oedema in these cases to asystole, but in two cases I have found oedema of the ankles wlien there has been distinct cardiac hyi)ertrophy and no in- dications I'roin the pulse of any systolic failure, and I should rather refer tlie dropsy to a vaso-motor origin. The ophthalmoplegia in Ca,se VII. is striking. Let us read the facts briefly. May 22.—Facial paralysis with no deafnosvs. ' Mari^, op. cU.; Debove, Soc. Med. dos H6p., June 1880. - .Sie Practitioner, Dec. 1891, 401, fEdnm.i in Ctraved' Disease. M»ude.