On paralysis of the third nerve as a complication of Graves' disease / by James Finlayson.

  • Finlayson, James, 1840-1906.
Date:
[1889?]
Catalogue details

Licence: Public Domain Mark

Credit: On paralysis of the third nerve as a complication of Graves' disease / by James Finlayson. 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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    ciated with cerumiuous accumulations, and perforations of the- membrana tympani. Coming now to the eye symptoms, it may be said that no indi- cation of present or past exophthalmos could be traced. On her first admission, in May, 1888, there was a very notable, although not complete, droop of the right eyelid. She reported that she had had severe headache, one night in May, 1887, about twelve months before admission, in the right temporal region, and next morning she was unable to open the right eye. This droop per- sisted more or less, although during her second residence it was not quite so noticeable. On further examination, the right pupil was found dilated, and there was no contraction with light or on attempting to accommodate. There was an extremely marked divergent paralytic squint of the right eye, and diplopia could be made out in certain directions. There was marked immobility of the right eye in all directions except outwards; all the muscles seemed paralysed except the external rectus, and perhaps the superior oblique. The visual acuteness in both eyes was dimin- ished, especially in the right. On ophthalmoscopic examination, nothing but a certain pallor of the discs was found by Dr. T. Eeid. There was no paralysis of the face, and her sense of smell and taste seemed good. There was thus an isolated paralysis of the third nerve on the right side, involving the movements of the eye- ball and of the iris, and partially involving the elevation of the upper eyelid. She improved considerably during both residences in the hospital, but the treatment need not be detailed here. During her first residence the peculiar paralytic symptoms in the eye seemed to me quite different from any complication of Graves' disease of which I had ever known; and I then made some search into the literature of the subject. I failed to find anything bearing on the matter except a paper by Dr. Bristowe. entitled Cases of Ophthalmoplegia complicated with various other affections of the Nervous System, published in Brain, vol. viii., 1886, p. 313, and afterwards reprinted by him in his Clinical Lectures and Essays on Diseases of the Nervous System, Lond., 1888, p. 69. It appeared that the illness of the same patient had been reported by Dr. Francis Warner; Ophthalmoplegia externa, complicating a case of Graves' Disease ; Medico-Chirargical Transactions, vol. lxvi., Lond., 1883, p. 107. In my case, however, the paralysis was of the third nerve and not an ophthalmoplegia, and it differed in other important respects also from Dr. Bristowe's. On the second admission of my patient, I discovered an im-