. Diseases of the nervous system : for the general practitioner and student. may be unilateral or bilateral. The cranial nerves-symp-toms depend upon the nerve or nerves affected by the tumor. In ex-ceptional cases the neives alone are involved and there may be no paraly-sis of the extremities. There are also cases in which the nerves are notinvolved and there is only paralysis of the limbs. This possibility willoccur only in lesions of the upper part of the pons. When trie lesion isin the middle of the pons there may be a paralysis of the limbs also of theface on the side opposite the lesion,
. Diseases of the nervous system : for the general practitioner and student. may be unilateral or bilateral. The cranial nerves-symp-toms depend upon the nerve or nerves affected by the tumor. In ex-ceptional cases the neives alone are involved and there may be no paraly-sis of the extremities. There are also cases in which the nerves are notinvolved and there is only paralysis of the limbs. This possibility willoccur only in lesions of the upper part of the pons. When trie lesion isin the middle of the pons there may be a paralysis of the limbs also of theface on the side opposite the lesion, which then lies above the decussationof the central facial fibers. If the tumor is so extensive as to involve themedulla, cerebellum or other neighboring tissue, the symptomatology willbe more complex: unilateral paralysis of the palate, vocal cords, tongue,ninth, tenth, eleventh, twelfth nerves. Polyuria, disturbance of respirationand of heart beat are indications of bulbar involvement. Vertigo, tituba-tion show involvement of cerebellar peduncles. Diminution of central. DISEASES OF MEDULLA, PONS AND FOURTH VENTRICLE 239 visual acuity depends upon the involvement of the anterior quadii-geminal bodies; deafness upon a lesion of the posterior quadrigeminalbodies. Sensory disturbances are present mainly in tumors of the tegmentum(see Anatomy); there may be either hemianaethesia or generalized anaes-thesia. Hemianassthesia is quite frequent. Not infrequently it accom-panies the hemiplegia. The disturbance of sensation is according toMarinesco due to the involvement ofthe mesial fillet and formatio reticularisin its ventral part (see Anatomy). Like in hemorrhage and softening,dysphagia and dysarthria are also pres-ent and even quite frequent in is caused by involvment ofthe medulla, dysarthria—by involve-ment of the central fibers of the hypo- ^jgf _r . — ,.glossus. Anarthria implies a bilaterallesion in the pons. FlG- in the Pons. J . r . , Secti
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Keywords: ., bookcentury1900, bookdecade1910, booksubjectnervous, bookyear1913
