. A treatise on the nervous diseases of children, for physicians and students. rogressive muscular atrophy is very great (see ChapterXXII), and it is only by the association of this progressive muscular atrophywith dissociated disturbances of sensation, and with the trophic symptomsdescribed above, that we can differentiate between syringomyelia and progres-sive muscular atrophy, as well as amyotrophic lateral sclerosis. In progressivemuscular atrophy of the Aran-Duchenne type, there are no marked disturb-ances in the skin and subcutaneous tissue ; and in amyotrophic lateral scle- 330 THE NERV
. A treatise on the nervous diseases of children, for physicians and students. rogressive muscular atrophy is very great (see ChapterXXII), and it is only by the association of this progressive muscular atrophywith dissociated disturbances of sensation, and with the trophic symptomsdescribed above, that we can differentiate between syringomyelia and progres-sive muscular atrophy, as well as amyotrophic lateral sclerosis. In progressivemuscular atrophy of the Aran-Duchenne type, there are no marked disturb-ances in the skin and subcutaneous tissue ; and in amyotrophic lateral scle- 330 THE NERVOUS DISEASES OE CHILDREN. rosis there are no disturbances of sensation, and no marked trophic symptoms,but in this disease and in syringomyelia the reflexes may be exaggerated. In syringomyelia other symptoms occur, which will depend largely uponthe extent of the cavity formation. If the cavity encroaches very largelyupon the anterior gray matter, there will be a large amount of flaccid atrophyand paralysis, the electric reactions will be disturbed, and the reflexes will be. Fig. 76.—Section through Seventh Cervical Segment, showing Gliosis of Cord. (Herter.)* diminished in the parts governed by the affected region. Fibrillary tremor ispresent in some cases. All these symptoms are generally most pronouncedin the upper extremities, since the cavity is greatest in the cervical region, andif the lateral columns in the cervical region are involved, we may expect a spasticparalysis of the lower extremities with increased reflexes, rigidity, and con-tractures. Cutaneous reflexes are, at times, normal, at other times diminishedor entirely absent. Hyperidrosis or hypidrosis (unilateral or bilateral) havebeen reported. In the cervical cases a narrowing of the palpebral fissure and * This and the following figure are reproductions of specimens prepared and pho-tographed by Dr. Herter, and kindly furnished me for use in this book. TUMORS OF THE SPINAL CORD AND ITS MENINGES. 33 r contrac
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