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 |   Related post: explanation of the great difference in the state of the reflexes in cases of p vrapleiiia due to lesions of the cord Anafranil 50 Mg in its middle and upper portions, beyond the circumstance that in some the lesion is a complete trans- verse one and in others incomplete, must at present be almost purelv St! MISCELLANY. (x\. Y. Med. Jouh- liy|ii>tlii'tifiil. I)i'. Hastiiin, followiiid an I'iirlier su^'nosiion by Dr. Uii^hlings Jaektion, liclii'vcs that «c must assiiiiie a double ooritiuUing artioii by tlie lu'aiu ovef tlio functions of the coiil. The ceiebiuin ex- erts a regulating or inliil)iting influence over the purely spinal reflexes, and when this controlling influence is witlulrawn, in confcquence of cerebral lesions on the Buy Anafranil one hanil, or sclerosis or other lesions affecting the lateral columns on the other, the spiiuil centers act in an exag- gerated and unregulated way. The controlling or inhibitory influences evidently pass downward along Anafranil Buy the pyramidal tracts. But how ac- count for the absence of this exaggeration when the lesion affects a complete cross-scclion of the cord, since certainly the controlling influ- ence must here Purchase Anafranil be completely withdiawn ? The suggested explanation is that the cerebellum has, as part of its function, the duty of keep- ing up the state of tonus in the muscles, acting through the cord; and that its influence in this way Order Anafranil is communicated downward in some part of the sensory columns. When this stimulating or tonic influence is withdrawn, by destruction of the sensory tracts in the posterior and central portions of the cord, the spinal centers are unable to effect a Ocd Anafranil response in the form of a reflex contraction. Tlic importance of this new doctrine is considerable in regard to diagnosis, and still more to prognosis, and sometimes to treatment. In cases of injury to the spine, followed Anafranil Online by lax paraplegia with complete loss of knee and ankle reflexes, the necessary conclusion would seem to be that, if this condition persisted after shock had passed off, recov- ery would be hojieless, and that no benefit was to he expected from any operative measures adopted with the view of relieving pressure. So long, on the other hand, as the reflexes are preserved, even though the pa- ralysis is very complete, there is hope of recovery, since the whole thickness of the cord has not been affected by the destructive lesion. .Vud that recovery may occur, even under very unfavorable Anafranil Price conditions, is clearly shown by a case of Charcot's, in which the patient bad been affected with and recovered from paraplegia, associated with vertebral disease and angular curvature. When she died, two years after, it was found that the spinal cord, at the level where compression had existed, was Online Anafranil no larger than a goose-quill, and when cut, its section was not more than about one Cheap Anafranil third of that of a healthy spinal cord examined in the same region. (Charcot, Di.seaxen of the Nervons System, second series, p. 80, N. S. S. translation.) Locomotor ataxy has already been referred to as Anafranil For Ocd one of the diseases very regularly associated with loss of patellar reflex. That the asso- ciation is not an absolutely constant one has been repeatedly shown, some at least of these exceptional cases being where the disease began in the cervical portion of the cord, instead of in the lower portion, as is the rule. Occasional cases of hemiplegia, occurring in persons al- ready the subjects of locomotor ataxy, have been recorded, and in a few of these it has been noted that the patellar reflex was present. But with the exception of a case, reported by Dr. Hughlings Jackson and Dr. Taylor (Britixh Mnlical Journal, July 11, 1891), it does not seem to have been noticed whether the knee-jerk was absent previous to the coming on of the hemiplegia. In this patient the ataxic symptoms had existed for about twelve years when he came under observation. He had then had two attacks of hemiplegia, the second eight days before admission, the right side being affected, and the knee-jerk aboent on both sides. Forty-seven davs after the second attack it was noted that there was slight return of the right knee-jerk. Two years after, the right knee-jerk was readily obtained, and a slight jerk could also be got on the left side, though with difficulty. Some of the ataxic symptoms had improved, while others had remained stationary, or be- come aggravated. Here, then, there was a remarkable instance of restoration of a normal physiological phenomenon, apparently resulting from the addition of a fresh disease, a cerebral lesion with secondary lateral sclerosis of the cord, to the original disease, posterior sclerosis, Anafranil Ocd which had caused its abolition. It is difficult to account for the restoration of reflexes in this case, and the authors of the paper only venture the suggestion that a few fibers had remained intact in the posterior columns, but that they had been in- sufficient to convey strong enough impressions from the periphery, till the sclerosis came on, and by stimulating the anterior horn made it more prone to respond to slight impressions. In view, however, of the cases collected bv Bastian and others, in which the occurrence of de- sccniling scleiosis, following lesion of the cord, led niither to increased reflexes nor contracture, it i.s not easy to accept the sclerosis in this case as, per se, Anafranil 150 the cause of the restoration of the patellar reflex. In accordance with the facts and arguments already adduced, it sceme a more probable supposition that the descending sclerosis acted rothcr in the way Anafranil Buy Online of cutting off, more completely than before, any remains of cerebral control. In the absence of inhibiting influence, the few fiboi - left in the posterior columns might be in a position to convey iuipjv sions, strong enough to stimulate the now unrestrained automatic molo centers in the anterior horn. 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