A case of crossed hemidysergia and tremor, with asynergia of binocular movements : comments / by Tom A. Williams.

  • Williams, Tom A. (Tom Alfred), 1870-
Date:
1910
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Licence: In copyright

Credit: A case of crossed hemidysergia and tremor, with asynergia of binocular movements : comments / by Tom A. Williams. 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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    The speech is very uncertain, and toneless. When binocular fixation is attempted, asynergic dissociation occurs. The kaleidoscopic series of squints which ensues produces a most weird effect. When either eye is closed, however, the other can perform all movements, although the right eye only does so with much difficulty and wide tremor. On looking widely to the right with both eyes open, the left eye moves across normally, while the right fails to follow suffi- ciently. The same phenomenon occurs with the left eye when the gaze is directed towards the left. In each case, vehement urging overcomes the motor incapacity, and the eyes for the moment fix the same spot, the laggard, however, quicldy relapsing. When he en- deavors to fix with his gaze a point 18 inches distant, he sees double, and the optic axes are noticed to converge. April 30 he had been taking hydrargyri iodidum gr. J t.i.d., and can now converge and externally rotate the right eye in binocular vision with less difiiciilty and urging than before, though he cannot maintain the position completely and though diplopia stiU exists. The diadocokinesis and incoordination of the left leg and arm have improved, and he can better control the pro- trusion of his tongue. The face trembles less, but his attempts at grimaces are accompanied by associated movements, especially in the left finger. There is no apparent asynergia revealed by the leaning back or chair-mounting tests. May 4 the ocular movements are better performed; there is less ataxia. The speech is clearer, but the diadocokinesis is still much impaired. Nov. 15. He failed to return to the hospital during the summer, and the mental symptoms and trembling became much worse, but two months ago a local practitioner accidently treated him, and caused a remission of the debacle. When examined, he presented much less tremor of the right cheek, though now the whole tongue trembled coarsely, somewhat in the same manner as, though less extensively than, on April 23. The movement is more of a dysmetric than of a trembling kind. The control over his facial muscles i