Organic and functional nervous diseases; a text-book of neurology . sis. There isusually a weakening of the mind, a dementia, and not uncommonly someform of aphasia. And in these cases evidences of arterial disease aidthe diagnosis as well as the non-progressive course of the symptoms. Finally, it is necessary to differentiate bulbar paralysis from as-thenic paralysis or myasthenia gravis. The symptoms in myasthenia 620 BULB AM PAEALYSIS. gravis are much like those of bulbar paralysis, though ptosis, paralysisof the orbicularis palpebrarum, and weakness of the muscles of the neck,which are ver
Organic and functional nervous diseases; a text-book of neurology . sis. There isusually a weakening of the mind, a dementia, and not uncommonly someform of aphasia. And in these cases evidences of arterial disease aidthe diagnosis as well as the non-progressive course of the symptoms. Finally, it is necessary to differentiate bulbar paralysis from as-thenic paralysis or myasthenia gravis. The symptoms in myasthenia 620 BULB AM PAEALYSIS. gravis are much like those of bulbar paralysis, though ptosis, paralysisof the orbicularis palpebrarum, and weakness of the muscles of the neck,which are very rare in bulbar palsy, appear early in myasthenia,Furthermore, in myasthenia a great general muscular lassitude andundue fatigue on exertion is quite constant, so that a few movementsexhaust the patient completely, rendering him incapable of walking orof using his hands. The rapid onset of this general muscular weak-ness is sufficient to differentiate the disease even from cases of amy-otrophic lateral sclerosis beginning with bulbar symptoms. The elec- FiG Section of muscle showing lymphoid infiltrations. The letters indicate a strand of con-nective tissue surrounded by the infiltrating cells. (Hun.) trical excitability of the muscles diminishes progressively as the currentis applied, until no contraction can be produced, yet after a period ofrest it is found to have returned. This peculiarity, termed electricalfatigue of a muscle, is characteristic of the disease, as shown by Jollyand Murri. The muscles which are affected show no fibrillary tremor,do not atrophy and show no reaction of degeneration. There are nosensory symptoms. The course of the disease differs from that inbulbar palsy, for while the onset may be similarly slow and the varioussymptoms may all be alike in bulbar and asthenic paralysis, the diseaseis not steadily progressive. Periods of improvement or even entiresubsidence of the symptoms occur. The patient may recover and befree from all sign
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Keywords: ., bookcentury1900, bookdecade1910, booksubjectnervoussystem, bookye
