Study of a case of bulbar paralysis : with notes on the origin of certain cranial nerves / by Howard H. Tooth and William Aldren Turner.

  • Tooth, Howard Henry.
Date:
1892
Catalogue details

Licence: Public Domain Mark

Credit: Study of a case of bulbar paralysis : with notes on the origin of certain cranial nerves / by Howard H. Tooth and William Aldren Turner. 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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    2. Distribution of the disease in the central grey matter. —This consists of atrophy and disappearance of the multi- polar nerve cells, which are included in Dr. Hughlings Jackson’s “lowest level” (the bulbo-spinal centres), with the important exception that the oculo-motor nuclei are usually not degenerated. The greatest amount of atrophy is in the hypoglossal nucleus. The cells of the corpus dontatum of the inferior olive have been found affected by only one observer.1 The nucleus ambiguus was found atrophied by Kronthal;2 usually it is unaffected, as also is Clarke’s column. 3. Condition of the peripheral nervous system.—De- generative changes have been observed in the peripheral nerves in some cases. Joffroy and Achard3 noted a paren- chymatous degeneration of the nerves of the extremities in a case of this nature. Kronthal (loc. cit.) describes degen- eration of several cranial nerves, while the peripheral spinal nerves were unaffected. Oppenheim,4 in a case of chronic anterior poliomyelitis, found slight degenerative change in the mixed nerves, while the anterior roots were healthy. But it must be borne in mind that in many instances no change has been found in the peripheral nervous system. 4. Nature of the change in the central nervous system.— The sclerosis is in appearance similar to that of descending degeneration resulting from a cerebral lesion. That it is not due to a diffuse chronic myelitis is evidenced by the fact that the periphery of the cord, which is usually affected by the inflammatory condition, here completely escapes, and also the posterior columns. Whether the change be originally parenchymatous or interstitial is difficult to determine, as in the later stages the resulting sclerosis is the same ; and early stages of this disease do not, as a rule, admit of pathological examination. Leyden observed that the axis cylinders were never hypertrophied, as occurs in disseminated sclerosis. 1 Maier: Virch. Archtv., vol. 61. 2 Loc. supra cit. 3 Loc. supra cit. 4 Oppenheim: Arch, fur Psycli. (Quoted by Ormorod, loc. cit.) Bd. xix.