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 |   Related post: Paralysis of the right leg occurred first and was soon followed by paralysis of the left. Numbness was first noticed about the first of October and was soon followed by retention of urine. There was likewise anaesthesia. The right knee-jerk was absent, and the left was minus. This was somewhat different from the type pictured by Erb, and chiefly in the condition of the knee-jerks, and yet the pathological findings are not unlike those which have been observed in cases of syphilitic spinal paralysis. Unfortunately, all the cervical cord was not obtained, and yet in the upper cervical and upper thoracic por- tions the process was very slight and caused no distinct symptoms, whereas in the midthoracic region especially the alterations were very noticeable. The thickening of the basilar artery in this case, so characteristic of syphi- lis, shows a well-known fact — i. e., that spinal syphilis is not confined strictly to the cord, even when there are no symptoms pointing to cerebral disease. Had the process not extended quite so far downward, the knee- jerks would have been preserved or even exaggerated, for since the investigations of Westphal and others we know that 'this reflex arc is situated in the upper lumbar cord. Had death occurred later, the symptoms would probably have become less severe, as we may judge from the his- tory of many other cases. Oppenheim % says that he and Lamy have observed cases of cerebro-spinal syphilis which finally resulted in the form described by Erb. In assuming that the knee-jerks would have been ex- aggerated in this case had the lumbar cord been intact, and that the clinical picture would then not have been unlike Erb's type, no claim is made which will probably call forth much criticism, in view of the degeneration of the lateral columns, for it is a generally accepted fact that degeneration of the pjTamidal tracts, if the pos- terior columns in the lumbar region and the peripheral neurones are intact, usually causes exaggerated reflexes; and one explanation which has been given is that cere- bral inhibition is in this way removed, and peripheral * Oppenheim. Berliner kUnisehe Woehensrhrift, 1893, p. 837. f Trachtenberg. ZeiUehrift fiir klinwche Medieiv, vol. xxvi, 1894. t Oppenheim. Die si/philitischen Erkrankungen des Gehirns, p. 177. Sept. 25, 1897.] SPILLEIi: SPINAL SYPHILIS. 413 irritation is transmitted to the motor cells of the spinal cord without any restraining cortical influence. The muscles are therefore in a condition of constant hyper- tonia. This theory, however, can not explain the cases of hypotonia with exaggerated reflexes. The pyramidal tracts have been better studied than any others in the central nervous system, and yet we are far from thor- oughly understanding their physiologj'. As van Ge- huchten Buy Danazol * reminds us, in complete transverse lesions of the upper part of the spinal cord the muscles of the lower part of the body are always flaccid and there is abolition of reflexes, and yet there is descending de- generation of the pyramidal fibres. Bischoff f has recently published an interesting paper on this sub- ject, and has attempted to explain this fact, which was first made prominent by Bastian. In rapidly develop- ing, complete, transverse lesion of the cervical and upper thoracic cord the vasomotor nerves are also paralyzed. As a result of this, the abdominal blood-vessels are dis- tended, and there is ansmia of the lumbar cord, with loss of tendon reflexes, which becomes a permanent loss if organic changes develop. In cases of slow devel- opment the cause of the absence of the reflexes must be sought in such conditions as secondary Danazol 200 degeneration of the muscles and nerves, or in involvement of the lumbar cord by secondary degeneration. It has been accepted by many that the contracture of hemiplegia is due to descending degeneration. Con- tracture and increased reflexes are frequently associated, and it is possible that the former is often a result of the latter. There are contractures of other types, such as are seen in flaccid paralysis, and these are probably Danazol Price ^ue in large part to malposition and decrease in size of the mus- cles from disuse. It is very doubtful whether con- tracture is really due to degeneration of the pyramidal tracts alone. We still have much to learn concerning the pyramidal tracts. The recent experiments of Wertheimer and Lepage J have caused much perplexity. These in- vestigators cut the pyramids in the dog, and yet electrical Danazol 200mg irritation of the cortex caused contraction of the limbs. The only explanation which seems possible is that other fibres than those in the pyramidal tracts Purchase Danazol must have con- veyed the impulse downward. Even if this is true of the dog, it does not Order Danazol follow that the same results could be obtained in man under similar conditions. We know that in some of the still lower forms the motor fibres are in the posterior columns. Van Gehuchten seeks to ex- plain the results obtained by Wertheimer and Lepage by a hypothetical motor cortico-ponto-cerebello-spinal tract. which is supposed to be closely connected with the Danazol 200 Mg motor Related links: Norvasc 7.5 Mg, Erythromycin Rxlist, Glycomet 500 Sr, Lidocaine Creams, Desyrel 75 Mg, buy furosemide, Amoxicillin And Clavulanate Potassium 875 Mg, Ciplox Eye Drops, Buy Lincomycin, Captopril Capoten
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