Is a brachial monoplegia always most marked in the hand? / by G. Bergmark.

  • Bergmark, Gustaf, 1881-
Date:
1910
Catalogue details

Licence: In copyright

Credit: Is a brachial monoplegia always most marked in the hand? / by G. Bergmark. 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.

    20/29 (page 214)
    There is no reason to suspect a real brachial neuritis, especially a fresh one. The patient, a man 60 years of age, with a bad vascular system, received while drunk an injury on the left side of the head, followed the next day by paralysis of the right arm. The paralysis may, of course, have been a direct result of the injury, but, on the other hand, it may have been caused by pressure on the plexus during unconsciousness. The distribution of the paralysis, as this appeared three months later, viz., to the deltoid, triceps, biceps, and brachial muscles, accords well with a lesion of the plexus, according to Erb’s type, and so does the diminished power of external rotation of the arm and supination of the hand. The condition of the muscles, on the other hand, is against the assumption of a lesion of the plexus. The paralysis following- lesion of the plexus is always of an atrophic nature (Oppenheim), but there was in this case neither atrophy nor alteration of the electrical reaction three months after the commencement of the illness, and when I examined the patient myself, nearly six years later, I found the paresis, although diminished, still evident and almost unchanged as regards its extent, but there was no sign whatever of atrophy. On the contrary, the circumference of the right arm was somewhat increased. The process had progressed none the less to a certain degree, internal rotation of the arm being weaker. Further, some flaccidity of the great pectoral muscle could be noticed on the right side. A similar propagation of the process to the pectoralis major alone may easily be explained by the assumption of a cerebral lesion, but not by the assumption of a plexus lesion, as the nerves supplying the great pectoral muscle, viz., the anterior thoracic nerves, originate from the most proximal part of the plexus. Further, the condition of the reflexes are also against the existence of Erb’s palsy (Grenet). During the patient’s stay in hospital in 1902 the triceps reflex was active on both sides. When examining the patient myself I found increased reflex irritability of the right arm as well as of the leg; and, in addition to this, Babinski’s sign was at this time observed on the right side, though it was inconstant. These facts seem to justify the assumption of a cerebral lesion as the cause of the paralysis, and in view of the partial type shown from the first by the lesion, it can hardly have been anything but a cortical one.