Text-book of nervous diseases for physicians and students Volume 1

This historic book may have numerous typos and missing text. Purchasers can download a free scanned copy of the original book (without typos) from the publisher. Not indexed. Not illustrated. 1911 Excerpt: ...marked fluctuations in the intensity and extent of the motor disorders may be found from day to day. The bladder and sensory symptoms also show the same variability. This fluctuation is particularly characteristic with regard to the tendon reflexes; thus the knee jerks were in some cases quite absent at certain times, present a few days later, and at other times were markedly exaggerated. In one case of this kind I found the posterior roots in the upper lumbar region embedded in granulation tissue and partially atrophied, and I thought that this variability of the symptoms might be due to alterations of pressure within the membranes. Although this variability may occur in other diseases, such as sarcomatosis of the spinal cord (Nonne, Mamlock1), it has been very pronounced in many cases of spinal syphilis. Ataxia is a not uncommon symptom, and it may also show the same inconstant character. 1 Prog, mid., 1897. » A. f. P., xxxvii. Finally, we must refer to one important factor. In many instances a similar disease develops in the brain, i.e. in the basal meninges and vessels, the symptoms of which may accompany or precede the spinal form. This cerebro-spinal meningitis represents in my opinion (my cases being supported by those of Siemerling, Eisenlohr, Sachs, Gerhardt, Pick, Homen, Henneberg, Nonne, Kopczvnski, and many other writers) one main form of syphilitic disease of the nervous system. The brain symptoms are, it is true, usually so very prominent that the spinal symptoms are masked and overlooked. Gerhardt2 draws attention to the triplegia which may exist, i.e. the paralysis of three extremities, which arises from the union of a hemiplegia and a paraplegia. Williamson also mentions this symptom. We need hardly expound in any detail the fact that ...