AMAarchives of neurology & psychiatry . th or sixth cervical segments; (2) to the upper extremitiesin involvement of the eighth cervical and first and second thoracicsegments; (3) between the shoulders in involvement of the eighthcervical and first five thoracic segments; (4) around the chest ininvolvement of the third, fourth and fifth thoracic segments; (5) tothe epigastrium from the eighth to eleventh thoracic segments; (6)to the back from the fourth to eleventh thoracic; (7) to the leg fromthe cauda equina. In one case pain was referred to the shoulder when the tumor waschiefly on the medu
AMAarchives of neurology & psychiatry . th or sixth cervical segments; (2) to the upper extremitiesin involvement of the eighth cervical and first and second thoracicsegments; (3) between the shoulders in involvement of the eighthcervical and first five thoracic segments; (4) around the chest ininvolvement of the third, fourth and fifth thoracic segments; (5) tothe epigastrium from the eighth to eleventh thoracic segments; (6)to the back from the fourth to eleventh thoracic; (7) to the leg fromthe cauda equina. In one case pain was referred to the shoulder when the tumor waschiefly on the medulla oblongata fFig. 5), although the uppermostcervical segments were involved. The patient (Case 1) had complainedfor five years of pain in her left shoulder, and to a less extent in theleft upper limb. The left shoulder had become atrophied during threeyears. Pain is not always strictly confined to the distribution of thenerve or nerve roots irritated; it seems to radiate into adjoining ter- 464 AKCIlllIlS OF hEUKOLOGY AM) PSVCIIIATRY. Fig. 5 (Case 1).—Situation of a tumor partly in the spinal canal and partlywithin the posterior fossa. FRAZIER-SPILLER—SPIXAL CORD TUMOR 465 ritories, but it is striking that pain should be felt in the shoulder anddown the upper limb when the tumor is confined to the first and secondcervical segments. The third cervical segment gives pain fibers to thegreater part of the neck and the fourth cervical to the upper part ofthe limb over the shoulder; and a tumor high on the cord ix)ssibly mayinterfere with adjoining segments below by circulatory disturbances,edema or other means. We would raise the question whether irritation
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