A clinical lecture on remissions and relapses in insular sclerosis / by Thomas Buzzard.

  • Buzzard, Thomas, 1831-1919.
Date:
[1904]
Catalogue details

Licence: In copyright

Credit: A clinical lecture on remissions and relapses in insular sclerosis / by Thomas Buzzard. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    and attention. There is no articulatory difficulty. The ocular movements are good, but extreme lateral rotation is not well sustained to her right and when the eyes are turned to her left a few slow jerking movements are remarked, of a nystagmoid character. The jaw movements are equal and powerful on the two sides. There is no affection of sensibility in the face. There is no abnormality in the dis- tricts of the ninth, tenth, and twelfth nerves. In the upper extremities we find all movements powerfully performed and it may be said that there is no marked inten- tion tremor, but when, by request, she touches the tip of her nose it is noticed that there is a slight wavy motion of the finger as it nears the face. In the lower extremities we find on the right side all movements present and power good. There is a little incoordination but no rigidity. On the left side the muscles are equally well developed but their power is much less and there is a great deal of spasticity. Dorsiflexion of the ankle is practically absent. Her gait is spastic, especially in the left leg, which is moved much like a hemiplegic limb. There are subjective numbness in the fingers, especially of the left hand, heavi- ness and dull pain across the loins, but no definite girdle sensation. Objectively there is no change to tactile stimulus. There is marked loss of sensibility to pain in the left leg as compared with the right, not quite constant, and extending from the foot (not including the sole) to above the knee without any definite limits. As regards reflex movements there is brisk jaw-jerk, the supinator jerk is in excess on the right side, the triceps jerk excessive on the right, absent on the left. The knee-jerks are both equally in ■excess and ankle clonus is present on each side. The plantar reflexes are both brisk and show extensor (Babinski) response. There is precipitate micturition with occasional incontinence of urine. Examination with the ophthalmoscope shows both discs rather pale, especially in the temporal half of each, and the left is more pale than the right ; the vessels are of good size. The field of vision, both to colours and light, is somewhat restricted concentrically in the left eye.” The patient for the last two years has been at home but attends to-day at my request. Her walking power since the above note was taken has much diminished and there is now some spasticity in the right lower extremity as well as in the left. I have entered into what is perhaps a somewhat wearisome detail of this case because it is one which manifestly strays