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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    ologie des Gehirns ” (Yol. iii., Case 20). The right lower extremity was markedly paretic. There was paresis of the sterno-mastoid.. At the shoulder the arm could be raised upwards only 45°.. The range of movements taking place at the right elbow joint- was normal. Both hands were paretic, but especially the right one. At the operation a tumour was found occupying the posterior central convolution on a level with the centre for the- leg. By means of electrical excitation the position of the centres for the muscles of the shoulder and neck were established, it being also ascertained that these were situated very close to the- tumour. The tumour was excised. After the operation the- right shoulder was dropped and could not be raised. But the forearm could be moved, and pronation and supination, as well as movements of the hand and fingers, could be accurately per- formed. The leg was highly paretic. Eighteen days after the operation rotation of the shoulder-joint could scarcely be per- formed, otherwise movements of this joint took place to a range- of 45°. At the elbow-joint flexion could be performed to about, a right angle, extension was almost normal, movements of the fingers normal. Three months after the operation the mobility of the shoulder-joint was 45°, of the elbow and wrist-joints- almost complete. All the movements of the fingers could be- performed, though weakly and without precision. Later on total hemiplegia developed. At the autopsy the- tumour, which occupied the upper third of the central convolu- tions and a part of the gyrus parietalis superior, was found to- reach laterally only slightly beyond the level of sulcus frontalis superior. The fact that before the operation a paresis of the hand was- present must be put down to remote action, together with the fact that the other hand showed reduction of the coarse power. This is consequently of less importance. But the course after the operation shows obviously that a process situated immediately above the centre for the shoulder-joint may affect the mobility of the shoulder-joint more than that of the elbow-joint, and the mobility of the latter joint more than that of the hand. Con- sequently also this case disproves Bonhoffer’s doctrine, and shows in the same way as the cases previously related that a cortical process may cause a marked paresis of more proximal parts of the upper extremity.