. A practical treatise on medical diagnosis for students and physicians . en. It is characterized by a spastic paraplegia, MULTIPLE SCLEROSIS. 1159 with exa^a:eniti<)n of the reflexes and (leg;enerati()n of the muscles. Spusmsare eouKiion, ami may give rise to muscular pains. The symptoms con-sist of weakness in the legs, which at the same time become stiff; themuscles rapidly atrophy ; there are fibrillary twitchiugs and reactions ofdegeneration. The arms are usually involved first, the degenerationcommencing in the muscles of the hands and giving rise ultimately to theproduction of variou
. A practical treatise on medical diagnosis for students and physicians . en. It is characterized by a spastic paraplegia, MULTIPLE SCLEROSIS. 1159 with exa^a:eniti<)n of the reflexes and (leg;enerati()n of the muscles. Spusmsare eouKiion, ami may give rise to muscular pains. The symptoms con-sist of weakness in the legs, which at the same time become stiff; themuscles rapidly atrophy ; there are fibrillary twitchiugs and reactions ofdegeneration. The arms are usually involved first, the degenerationcommencing in the muscles of the hands and giving rise ultimately to theproduction of various deformities, such as the claw-hand. The tendon-reflexes are greatly exaggerated ; there are patellar and ankle Babinski phenomenon is present. The muscles are greatly weak-ened, but remain rigid until late in the course of the disease. Thesphincters are rarely involved, the jnipillary reflexes are normal, andthere are no sensory disturbances. Bulbar symptoms—that is, paralysisof the larynx, pharynx, and palate—occur, giving rise to dysphagia^ Fig. Testing the Babinski reflex. dysarthria, and occasionally to entire loss of speech. In the early stagesof this complication there may be distinct jaw clonus, elicited by tappingupon the lower jaw or the chin. When the bulbar symptoms becomeadvanced, the lower part of the face is absolutely expressionless. It hasa mask-like appearance, and often saliva dribbles from the mouth. Inthis stage inspiration pneumonia, due to involvement of the laryngealbranches of the vagus, is quite common and usually causes death. Multiple Sclerosis. This is a condition that involves the spinal cord and brain. Thesituation of the lesions is not constant, and therefore the symptomatologyis variai)le. It usually commences at about the age of thirty years, and 1160 DISEASES OF THE NERVOUS SYSTEM. is more common in mon than in women. The characteristic symptomsare intention tremor, nystagmus, and scanning speech. The intentiontremor invo
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