Organic and functional nervous diseases; a text-book of neurology . l diseases. The differentiation of chronic anteriorpoliomyelitis from amyotrophic lateral sclerosis is as follows: In amyotrophic lateral sclerosis there is an increase in the knee-jerks 1 Arch. f. Psych.,, xxvi., 706. ^Deut. Zeitschr. fiir Nervenheilk., iii., 6. 292 CEBONIC ATBOPHIC PABALYSIS. early in the disease, an early development of Babinskis reflex — i. e.,retraction of the great toe and flexion of the other toes on tickling thesole — and increased mechanical excitability in the muscles that areparalyzed; a tendency to
Organic and functional nervous diseases; a text-book of neurology . l diseases. The differentiation of chronic anteriorpoliomyelitis from amyotrophic lateral sclerosis is as follows: In amyotrophic lateral sclerosis there is an increase in the knee-jerks 1 Arch. f. Psych.,, xxvi., 706. ^Deut. Zeitschr. fiir Nervenheilk., iii., 6. 292 CEBONIC ATBOPHIC PABALYSIS. early in the disease, an early development of Babinskis reflex — i. e.,retraction of the great toe and flexion of the other toes on tickling thesole — and increased mechanical excitability in the muscles that areparalyzed; a tendency to rigidity in the movement of the legs, andsome spastic rigidity of the arms; also, an increase in the tendon re-flex at the elbow and wrist. In other words, the symptoms of lateralsclerosis are added to the symptoms of progressive muscular atrophy,and it is by a discovery of these additional symptoms that the diagnosisis made. The progress of the case is usually more rapid in amyo-trophic lateral sclerosis than in chronic anterior poliomyelitis; and Fig. Atrophy of the muscles about the shoulder-blades and arms in a case of chronic anteriorpoliomyelitis. The triceps and lalissimus dorsi have escaped. bulbar symptoms either appear early in the aiFection or precede theparalysis in the limbs. A differential diagnosis from muscular dystrophy is to be made bya consideration of the progress of the case and the succession of im-plication of the various muscles, which is quite characteristic in thedifferent types of muscular dystrophy, and differs from that alreadydescribed. (See Muscular Dystrophy, Chapter XVI.) In musculardystrophy there is never any fibrillary contraction in the paralyzedmuscles. The atrophy of the muscles is often attended by a depositof fat, so that there is an appearance of hypertrophy in the muscles thatare really atrophied. The tendon reflexes in muscular dystrophy areprogressively diminished as the muscles become atrophied. The his-tory of the case,
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