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.

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    In one case with Jacksonian epilepsy, on account of a sub- cortical abscess, I could ascertain that the patient, during an attack of severe contractions in the muscles of the shoulder and elbow, retained the power of voluntary movements in the thumb. After the fit, when the monoplegia was otherwise complete, the patient was still able to move his thumb. In three other cases I found paresis of the fingers varying somewhat in degree, being in the two latter cases least and in the first most marked in the thumb. This was so also in a case lately observed by Professor Petren. The above statements seem to justify the assertion that from a clinical point of view also one may speak of localisation in Munk’s sense of the various subcentra for the arm and hand, as a lesion of the centre for the arm need not necessarily most affect the function of the hand, but may involve some other part of the upper extremity (the elbow or shoulder-joint), and if the hand is implicated its function need not be impaired as a whole, as several cases of more or less isolated paralysis of the fingers are known, and this applies to the coarse power as well as to the isolated movements. Besides this, Oppenheim’s case (Case 5), which I have pre- viously quoted, as well as my own (Case 1), indicate that a paresis or spasm due to a lesion situated above the capsule may also assert itself more proximally than distally in the lower extremity. With regard to the great majority of cases, however, it holds good, as has been stated by Bonhoffer, that the function of the hand is exclusively or most markedly involved, and this applies not only to cortical but also to capsular lesions. In some cases of vascular lesions of the cortex this can be explained by the distribution of the vessels. The centre for the shoulder lying opposite or somewhat below the sulcus frontalis superior is almost at the boundary of the areas of distribution of the anterior and middle cerebral arteries (Beevor), whereas the centre for the hand lies within an area supplied only by the middle cerebral artery. On this account the centre for the shoulder, and to a lesser degree that for the elbow, are more favourably situated as regards collateral blood-supply than is the centre for the hand in cases of vascular lesion within the area supplied by the middle cerebral artery. This simple explanation, however, may be hardly sufficient