Paralyses, cerebral, bulbar and spinal : a manual of diagnosis for students and practitioners / by H. Charlton Bastian.

  • Bastian, H. Charlton.
Date:
1886
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Licence: Public Domain Mark

Credit: Paralyses, cerebral, bulbar and spinal : a manual of diagnosis for students and practitioners / by H. Charlton Bastian. Source: Wellcome Collection.

Provider: This material has been provided by Royal College of Physicians, London. The original may be consulted at Royal College of Physicians, London.

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    powerless. Trousseau passed a very gloomy verdict on such cases, which certainly does not seem to be merited in all of them. More information is wanted concerning these cases, though probably they may be referred to three categories :— (1) . We may have cases of this kind caused by lesions wholly or in part cortical, in which the cortical leg centres are proportionately much affected. Or lesions may implicate the upper part of the in- ternal capsule in an unusual way, so as to involve the fibres emanating from the centres for the lower extremity more than those proceeding from the centres for the upper extremity. (2) . Other cases of this variety of hemiplegia are certainly met with where the lesion occurs in the pons Yarolii. Of this I have seen some well marked instances, and can refer to cases verified by post-mortem examinations. The possibility of such an occurrence from unilateral lesions in this locality, is rendered more explicable by reason of the topographical separateness of the motor fibres pertaining to the arm and leg respectively in this region, as Brown-Sequard long ago ascer- tained. (3) . Lastly, I believe there is another class of cases in which the leg is not originally more paralysed than the arm—in which, in fact, recovery begins to take place in the ordinary way—though it may soon be arrested so far as the leg is concerned. Such cases, there- fore, only seemingly belong to the variety of hemiplegia of which we are now speaking, when they are met with at a period remote from their origin ; they are, I suspect, not so much due to any peculiarity of the brain lesion, as to certain quasi-accidental extensions of sclerosis from the tract of 1 secondary degeneration ’ in the lumbar region of the spinal cord. In some of the cases in which the arm regains power before the leg, I have found that the several segments of the limb recovered in an order the reverse of that which is usual—namely, that power was first regained over the movements of the fingers and wrists, then over those of the elbow, and lastly over those of the shoulder joint. Hughlings Jackson has expressed the opinion that this inversed order of recovery of power in the different segments of the upper extremity obtains in all, or in almost all, the cases in which the arm recovers before the leg. This is also a matter that requires further investigation. My own experience does not enable me to share this opinion. Moreover, in cases where there is no reversed order of recovery as regards the leg and the arm, I have sometimes found the several- parts of the arm N