Nervous and mental diseases . rparalysis according as the lesion is irritative or destructive. Theinvolved muscles are the pterygoids, the temporal, and the generalized convulsions they are ordinarily involved. Very rarelythey are the sole seat of motor disturbance presenting a masticatoryspasm or paralysis. The spasm may be tonic, as in trismus, or repeatedat varying intervals. The teeth are tightly clenched, and the niasse-ters and temporals stand out firm and hard. In the clonic variety,as in the chattering of a chill, the lower jaw is sharply moved laterallyor vertically. Vigor
Nervous and mental diseases . rparalysis according as the lesion is irritative or destructive. Theinvolved muscles are the pterygoids, the temporal, and the generalized convulsions they are ordinarily involved. Very rarelythey are the sole seat of motor disturbance presenting a masticatoryspasm or paralysis. The spasm may be tonic, as in trismus, or repeatedat varying intervals. The teeth are tightly clenched, and the niasse-ters and temporals stand out firm and hard. In the clonic variety,as in the chattering of a chill, the lower jaw is sharply moved laterallyor vertically. Vigorous grinding of the teeth may be present. Thisis sometimes seen in the late stages of paretic dementia and in otherwide-spread organic brain disease. Single or repeated spasms may havetheir origin in local disease of the jaws, such as periosteitis or tooth-ache, and are then reflexly produced. Masticatory paralysis of cortical origin is extremely rare. Thecortical lesions have almost invariablv been found to be bilateral, but. Fig. 41.—Case of nuclear disease of the fifth cranial nerve in a case of tabes, snowing area of cutaneousanalgesia; some facial atrophy is also present. Hirt1 has reported a case of complete mandibular palsy due to a left-sided lesion at the foot of the ascending frontal convolution. Nuclear disease of the fifth nerve is usually a part of a group ofbulbar symptoms. Masticatory paralysis arising from this source is ex-tremely rare. Progressive bulbar palsy and pontine tumors may causeit, but other cranial nerves are almost invariablv affected at the sametime. Multiple sclerosis and tabes may and often do affect the fifthnucleus, causing bilateral sensory and motor symptoms in the area ofits distribution. Peripheral intracranial affections of the trigeminus may involvethe stem, the Gasserian ganglion, or the three branches of the nerve attheir exits from the skull. The differential diagnosis as to location may1 Berlin, klin. Woollens.,; 1887. 120 DISEASES
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