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

  • Bastian, H. Charlton.
Date:
1886
Catalogue details

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.

    212/720 (page 188)
    appearance which at first sight, whilst the face is in a state of repose, may be suggestive of a paralysis on the opposite side of the face (p. 180). When such a patient smiles or attempts to show his teeth, however, it will be found that the lower, or apparently paralysed, side of the mouth moves most freely. Early rigidity may show itself immediately after the commencement of a hemiplegic attack, whilst the patient is still in a state of apoplectic or epileptiform stupor. At other times, it does not present itself till two or three days after the onset of the paralysis. This kind of spasm may persist for many weeks or months, with only slight variations from day to day. The muscles do not show any signs of wasting for a long time, and they generally respond to faradisation rather more readily than those of the healthy side. We frequently find, with such a form of rigidity, that the spasm relaxes altogether during sleep, the muscles resuming their rigid condition during the act of awakening or as soon as the patient begins to move, as in other allied spasmodic states. As to the cause of these early rigidities, the generally accepted ex- planation is that which was originally advanced by Todd, namely, that they are due to the ‘irritative influence ’ of certain brain lesions or, perhaps, to a slight secondary inflammatory condition springing up in the tissues around the seat of lesion. Some such explanation may, perhaps, be the best that can be given with the view of accounting for those early rigidities which commence about the third or fourth day, and after lasting for one, two, or three weeks, again disappear. SuGh ‘ early rigidities ’ are, however, rare as compared with others now to be referred to. The great majority of early rigidities are, I believe, dependent upon the locality of the lesion; and, as will be seen, they are very closely related to, if not identical with, the so-called ‘ late rigidities/ This holds good even for some of the cases in which rigidity shows itself from the very first, and afterwards remains, month after month, with mere slight fluctuations from time to time. Of this type I have lately seen a well marked example, where the general group of signs pointed strongly to the existence of a small haemorrhage in the pons Varolii. This, in fact, is one of the regions in which the occurrence of lesions is apt to be associated with early rigidity. It is likewise met with where lesions exist in the thalamus, or just outside this body and the posterior extremity of the corpus striatum; and also in association with lesions in, or contiguous to, the excito-motor area of the cortex.