Diseases of the nervous system / by Judson S. Bury.

  • Judson Sykes Bury
Date:
1912
Catalogue details

Licence: Public Domain Mark

Credit: Diseases of the nervous system / by Judson S. Bury. Source: Wellcome Collection.

    123/856 (page 95)
    the paralysed side, while the plantar reflex is of the extensor type. As a rule the nutrition of the muscles does not suffer, hut occasionally muscular atrophy occurs especially in the hand muscles, when it is often conspicuous in the abductor indicis. This wasting may he due to changes in the spinal motor cells owing to their not receiving proper impulses from the upper neurons, or to an asso¬ ciated peripheral neuritis. Coldness, lividity and sometimes oedema affect the extremities of the paralysed limbs; even more severe trophic changes may occur, as blisters filled with dark serum, or sloughs over points of pressure, as over the trochanter, gluteal region, and the malleoli. Inflam¬ mation of the larger joints is occasionally met with. In many cases the mental condition becomes gradually impaired; the memory is defective, the disposition is altered and there is an abnormal tendency to emotional disturbance, the patient laughing or more usually crying on the slightest provocation. This post-hemi- plegic dementia is probably less the result of the focal lesion than of an associated and extensive degeneration of the cerebral vessels. Nature of the Lesion. Omitting cases of infantile hemiplegia, which are considered later (see p. 99), the common lesions involving the motor fibres of the internal capsule are haemorrhage and softening, the latter being a result of embolism or of arterial throm¬ bosis. Occasionally the lesion is a tumour pressing on the capsule, but in such a case paralysis develops very slowly, one limb being affected some days or weeks before the other; and as a rule one or all of the classical symptoms of cerebral tumour are present, viz., headache, vomiting, and optic neuritis. In a young person, embolism from heart disease and thrombosis from syphilitic endarteritis are the common causes of hemiplegia. An occasional cause of throm¬ bosis is the blood-state associated with the post-puerperal condition. In persons over forty, haemorrhage or