Nervous Manifestations Research Articles

The central pain systems

The central neurone systems are dealt with, which are activated by painful stimulation of the skin or are influenced by the central effects of such stimulation. Pain is a central nervous manifestation. While there is no specific peripheral receptor system for pain, that system extending from spinal posterior horn to thalamus has a close relationship with the experience of pain. Many fibres of the spinothalamic tract run to the nuclei of the reticular formation of the medulla oblongata, of the pons, and of the midbrain from which nuclei secondary connections are made with thalamus and subthalamus. Through them the reticular activating system with its arousal effects can be stimulated. Collaterals to the periaqueductal grey matter could serve as a basis for the affective reactions to pain stimuli. In the region of the thalamus a sub-division occurs (a) in a cortical pain conduction over the small celled caudal ventral nucleus (V. c. pc) which when stimulated in man results in severe pain, to the koniocortex area 3 b of the posterior central gyrus, stimulation of which scarcely ever provokes typical pain, and (b) in a subcortical pain conduction over intralaminar nuclei of the thalamus, over the nucleus limitans and perhaps over the centromedian to the outer segment of the pallidum. In order to relieve intractable pain permanently by means of thalamic coagulation it is necessary to destroy both the cortically dependent pain nuclei of the thalamus and to coagulate the nuclei responsible for subcortical pain control. — Extirpation of both II. sensory area produces no reduction of the pain.

Goitrous Hypothyroidism Simulating Thyrotoxicosis

SummaryA case of goitrous hypothyroidism in a boy of 13 is described which has been successfully treated with 260 mg of thyroid daily. The defect in this case may have been due to a failure in the coupling of iodotyrosines. For four years the patient was regarded as suffering from thyrotoxicosis. This was largely due to the association of goitre with nervous manifestations, viz. excitability, tremor and moist palms. An incorrectly interpreted radio‐iodine up‐take and an apparently raised B.M.R. were thought to support the diagnosis. Indications of the true diagnosis were the family history of goitre without iodine deficiency, the retarded physical development and bone age, the normal temperature of the palms, the failure to confirm the presence of the thyroid murmur, the absence of eye signs, the discrepancy between the sleeping and the waking pulse, the failure to respond antithyroid treatment and the good response to treatment with thyroid 30 mg three times daily before the diagnosis was established. The finding of a low P.B.I. clinched the diagnosis of hypothyroidism.

Chlorpromazine in the treatment of porphyria.

• Chlorpromazine was administered by mouth, generally in doses of 25 mg. three or four times daily, in nine cases of intermittent acute porphyria with pain and other serious symptoms. This dosage sufficed to control the symptoms in most cases, although it did not cure established paralyses. In three of the patients a single dose of 100 mg. of chlorpromazine was followed by complete clinical remission. The first effect was a relief of the nervous symptoms, including the pain; this improvement was not correlated with any significant changes in excretion of porphyrin or porphobilinogen during the period of study. The drug appeared to interrupt a vicious cycle, after which the patient was able to regain a state of remission spontaneously. Chlorpromazine has been the most consistently effective remedy thus far available for the pain and nervous manifestations of porphyria.

Diffuse lymphosarcomatosis of the central nervous system simulating infectious polyneuritis

1. 1. A brief review of the literature concerning the general aspects of diffuse tumor of the central nervous system, emphasizing principally those of lymphoid origin, is presented. 2. 2. A case of diffuse lymphosarcomatosis involving the central nervous system with silent visceral involvement is reported. 3. 3. The clinical and pathologic features of the case are discussed in relation to prevailing theories as to the nature of the nervous manifestations of these tumors. 4. 4. Criteria for early diagnosis of diffuse malignancy of the central nervous system are presented.

Porphyrin content of bone marrow and liver in the various forms of porphyria.

THE CLASSIFICATION of porphyria in the past has depended almost entirely on clinical features. Thus, Gunther divided the disease into acute, chronic, and congenital forms, the acute being characterized by episodes of abdominal and/or nervous manifestations; the chronic, by late appearance of photosensitivity with or without abdominal and nervous symptoms, and the congenital by early photosensitivity.1Waldenstrom substituted the term cutanea tarda for the chronic form and subdivided the acute cases into several types, solely on the basis of clinical features.2Micheli's classification was also a clinical one.3There has actually been no other basis for classification, owing to the lack of exact information as to the pathogenesis of porphyria and to the site of origin of the porphyrins in the various forms of the disease. The literature contains altogether too few data on the porphyrins of the various tissues to permit any judgment as to whether

Nervous manifestations in Eales's disease.

Nervous manifestations in Eales's disease.

Pityriasis rosea accompanied with Bell's palsy.

Mild, and even severe, constitutional reactions accompanying pityriasis rosea have been reported many times, but involvement of the nervous system is rarely recorded. Von Szaboky, 1 who did refer to nervous manifestations, merely generalized on the subject by mentioning sweating, trembling, pallor and redness, headache and exaggerated reflexes. Therefore, a case of pityriasis rosea accompanied with a unilateral paralysis of a facial nerve (Bell's palsy) is considered worthy of a report. C. F., a 15 year old white schoolgirl, first became ill with the common cold, accompanying which was an unusually severe headache. Three days later there appeared an eruption consisting of one large spot and several smaller spots on the right side of the trunk. The eruption was symptomless. A day later the patient noticed a peculiar feeling in the left side of the face, with inability to smile normally and inability to close the left eye. There

Fatal homologous serum hepatitis in a young infant: Case report with necropsy studies

Summary A case of fatal homologous serum hepatitis occurring in a 3-month-old infant seventy-three to seventy-seven days following the administration of whole blood and pooled plasma is reported. The symptoms of the prodromal period were gastrointestinal in type with diarrhea and vomiting but without jaundice. The terminal stage was sudden in onset with jaundice, multiple hemorrhages, and central nervous systems manifestations.

Scalenus anticus syndrome treated by surgery and skeletal traction

1. 1. Scalenus anticus syndrome is a common entity and a cervical rib may or may not be present. 2. 2. Most authorities believe that the nervous manifestations are the result of pressure on the lower trunks of the brachial plexus, while the vascular phenomenon is due to stimulation of the sympathetic fibers in the lowest trunk of the brachial plexus. 3. 3. The syndrome may be initiated by stimulation of the cervicobrachial plexus which in turn causes contraction of the scalenus anticus muscle. As a result of this contraction the thoracic rib is elevated into an abnormal position compressing the nerve trunks and subclavian artery which lie between the scalenus anticus muscle and the first thoracic rib. A vicious cycle ensues. 4. 4. It is possible that the syndrome may also be started by contraction of the scalenus anticus muscle due to direct trauma or irritation of the muscle. This may well explain the etiology of the syndrome in cases with a demonstrable organic disorder in the cervical vertebrae and in those patients who have a fracture dislocation of the cervical spine. 5. 5. Treatment should be directed both to the etiologic factors and to the contracted scalenus anticus muscle. Symptoms will often disappear with adequate treatment of the demonstrable condition if present in the cervical spine. If this fails, the treatment should be augmented by a direct attack on the scalenus anticus muscle. 6. 6. Many cases with mild symptoms will respond to conservative measures. If these fail, the patient should choose treatment either by traction or surgery. The author prefers surgery if not contraindicated. 7. 7. Skeletal traction is an excellent method of treatment for selected cases.

Clínica e terapêutica da doença de Chagas

1 - Baseados na experiência adquirida nos últimos cinco anos em Bambuí, Minas Gerais, onde mais de seiscentos casos de doença de Chagas tém sido estudados, os autores fazem uma revisão das manifestações clínicas desta doença. mencionam alguns dados sôbre a incidência da esquizotripanose e chamam a atenção para a importância social desta moléstia. 2 - Sugerem a seguinte sistematização das fórmas clinicas da esquizotripanose: a) Forma aguda; b) Formas crônicas: 1 - Forma indeterminada (cardiacos potenciais), 2 - Forma cardíaca (cardiopatia crônica). Os autores não encontraram no material estudado em Bambuí casos classificaveis como forma nervosa crônica. 3 - Apresentam evidências de ordem clínica e experimental que justificam admitir-se a cardiopatia crônica da doença de Chagas como entidade clinica definida. 4 - As manifestações da infecção aguda são estudadas à luz da experiência adquirida com os 103 casos agudos diagnosticados em Bambuí. Dois tipos de fenômenos edematosos podem ocorrer em pacientes com esquizotripanose aguda: o edema local, de porta de entrada do parasito, e o edema generalizado (o chamado "mixedema"). A patogenia dêste último é revista e sugere-se que ele seja devido a uma hipoproteinemia. O edema local parece de natureza inflamatória. As manifestações da cardiopatia aguda da doença de Chagas são descritas. Ritmo de galope, aumento da area cardíaca (em alguns casos devido a transudato pericárdico), prolongamento do espaço P-R, alterações primárias da onda T e extra-sístoles ventriculares - constituem os sinais mais importantes para o diagnóstico da cardiopatia aguda. Bloqueio de ramo direito foi encontrado em três casos fatais de cardiopatia aguda, um dos quais apresentou também pronunciado desnivelamento de ST (padrão de injúria). A morte durante a infecção aguda é usualmente precedida por manifestações convulsivas. Na maioria dos casos as manifestações, da infecção inicial regridem e o paciente passa à condição de cronicidade em aparente cura espontânea. Esta, entretanto, parece não ocorrer. 5 - Pacientes com infecção crônica e sem evidências de comprimento cardíaco são classificados como cardíacos potenciais ou forma crônica indeterminada. A infecção em regra permanece ativa e os sinais da cardiopatia podem desenvolver-se mais tarde. 6 - A cardiopatia crônica é usualmente manifestação tardia da infecção. Ela incide em cerca de 50% dos pacientes com infecção crônica. Suas manifestações dependem da extensão das alterações miocárdicas. Palpitações, dispnéia, crises convulsivo-sincopais (bloqueio A-V intenso), precordialgias atípicas e dôr no hipocôndrio direito (congestão passiva do fígado) são os sintomas mais comuns. Alguns casos não apresentam sintomas, o coração não se mostra aumentado e a única evidência da cardiopatia é fornecida pelo eletrocardiograma (cardiopatia assintomática). Irregularidades do ritmo cardiaco, desdobramento da 2ª bulha no foco pulmonar e ritmo de galope são achados auscultatórios frequentes. O aumento do coração é de grau variavel; ele atinge a todas as cavidades cardíacas. Doentes com insuficiência cardíaca em regra apresentam aumento pronunciado do coração. Predominam sinais de dilatação cardíaca sôbre os de hipertrofia. Não se encontram sinais de lesão valvular ou de alterações estruturais dos grandes vasos. A pressão arterial é usualmente normal; em casos de insuficiência cardíaca pode a pressão sistólica estar reduzida e a direfencial ser muito pequena. Sinais de insuficiência valvular funcional são muito comuns em casos com insuficiência cardiaca. Usualmente do tipo direito ou do tipo bilateral, a insuficiência cardiaca raramente assume o tipo insuficiência ventricular esquerda isolada. Na grande maioria dos casos o eletrocardiograma evidencia distúrbios da condução ou da formação do estímulo, ou ambos. Extrasistoles ventriculares, bloqueio de ramo direito, bloqueios A-V de todos os graus e altrações atípicas do complexo ventricular são os achados eletrocardiográficos mais importantes. O bloqueio de ramo direito é excepcionalmente comum neste tipo de cardiopatia e possúe grande valor diagnóstico em areas endêmicas. Os critérios para o diagnóstico diferencial com outros tipos de cardiopatia crônica são expostos. A evolução da cardiopatia crônica é variável, dependendo principalmente da atividade da infecção. A sobrevida é geralmente longa; entretanto, a maioria dos doentes morre antes dos 50 anos de idade. O prognóstico depende principalmente de gráu de aumento do coração e de redução da sua capacidade funcional, do tipo de arritmia presente e do potencial evolutivo da infecção crônica. A morte súbita é muito comum nesta cardiopatia; a maioria dos doentes, porém, morre em insuficiencia cardiaca. Não se dispõe ainda de medicamento eficaz para o tratamento etiológico da doença de Chagas. No tratamento da insuficiência cardíaca da cardiopatia crônica da doença de Chagas obtém-se frequentemente melhores resultados com a estrofantina ou a ouabaina do que com a digital.

EXCESSIVE SELF MEDICATION WITH NAPHAZOLINE HYDROCHLORIDE ("PRIVINE HYDROCHLORIDE")

Rhinitis medicamentosa is a condition frequently associated with allergy or sinusitis. Recently, however, there have been an increasing number of unusually severe cases associated with nervous manifestations following excessive self medication with naphazoline (privine hydrochloride N. N. R.). REPORT OF CASES Case 1.— A healthy man aged 28, who had been well until four months before, began using solution privine 0.1 per cent for a cold at the recommendation of a friend. His stuffiness became worse until he was using about 2 ounces (59 cc.) a week. He had lost 20 pounds (9.1 Kg.), was unable to sleep and was so nervous that he thought he was having a breakdown. Examination of the nose showed the turbinates to be grossly swollen; they were the dead gray color and the consistency of bubble gum. They could not be shrunk even by a mixture of cocaine and epinephrine (adrenalin

A HISTORY OF THE DEVELOPMENT OF THE CONCEPT OF FUNCTIONAL NERVOUS DISEASE DURING THE PAST TWENTY-FIVE HUNDRED YEARS

In perspective it is obvious that a relationship between psyche and soma has been observed during the whole history of medicine. Until well within the last one hundred years no one conceived of nervousness in terms other than visceral disease. During the past hundred years there has been increasing emphasis upon the importance of psychological manifestations of illness until, at the high point of this interest the soma was almost forgotten. The tide has receded until now the interest is in the interrelations of physical and mental factors. The difference is that early physicians thought in terms of visceral disease as causing nervous manifestation, while today we have reversed the trend and think of visceral disorder in terms of nervous disease. Reflection upon the history of medical thought may be profitable. The best minds of medicine have struggled with these disorders and contemporary fashion has been accepted as ultimate truth. The excellent descriptions show powers of observation of the highest quality, but the interpretation and the treatment are entirely matters of contemporary philosophy. To quote Lecky: The doctrine, that the opinions of a given period are mainly determined by the intellectual condition of society, and that every great change of opinion is the consequence of general causes, simply implies that there exists a strong bias which acts upon all large masses of men, and eventually triumphs over every obstacle. The inequalities of civilisation, the distorting influences arising out of special circumstances, the force of conservatism, and the efforts of individual genius, produce innumerable diversities; but a careful examination shows that these are but the eddies of an advancing stream, that the various systems are being all gradually modified in a given direction, and that a certain class of tendencies appears with more and more prominence in all departments of intellect. Nervous exhaustion, anemia, cerebral hyperemia, auto-intoxication, focal infection, glandular dysfunction, and psychogenesis have their day and then disappear except as matters of medical curiosity. This should lead us to a cautious, temperate and critical evaluation of present-day thought, in order that we may avoid, through excessive confidence, belief that the last hypothesis represents the ultimate truth.

Reidel's thyroiditis: Report of two cases

1. 1. Two cases of Reidel's Struma are herein reported. 2. 2. In both cases nervous manifestations were very marked, and when present with thyroid enlargement of stony hardness one should consider Reidel's Struma. 3. 3. Surgery afforded immediate relief in both cases.

Nervous and mental manifestations of bilharziasis and their treatment

1. 1. A case of myelitis with mental confusion is described and is shown to be due to bilharzial infection. 2. 2. Three cases of mental confusion associated with bilharziasis have been referred to. 3. 3. In all the four cases, specific treatment for the bilharziasis in sufficient doses cured the mental and nervous conditions. 4. 4. In one of the cases of confusion the encephalogram showed deformity in the wall of the lateral ventricle.

BENIGN LYMPHOCYTIC CHORIOMENINGITIS

The virus of benign lymphocytic choriomeningitis was first isolated and described by workers at the National Institute of Health in 1934. 1 Traub 2 at Princeton in 1935 and Lepine and Sautter 3 at Paris in 1936 recovered similar strains of virus from white mice, and Rivers and Scott 4 at New York in 1935 and also Findlay, Alcock and Stern 5 at London in 1936 isolated strains from human beings with nervous manifestations. These various strains affected animals in a similar manner and have been shown to be immunologically similar to the original strain isolated by Armstrong. 1 The virus is pathogenic for monkeys, guinea-pigs, mice and white rats and is capable of affecting many tissues and organs. For instance, Armstrong, Wooley and Onstott 6 demonstrated an abundance of the virus in the brain, lungs, kidneys, heart muscle, voluntary muscles, marrow, salivary glands, adrenals, spleen, liver, testicles and blood

Fracture-Dislocations in the Region of the Atlas and Axis, with Consideration of Delayed Neurological Manifestations and Some Roentgenographic Features

DISLOCATIONS and fractures of the first two cervical vertebrae have been accorded considerable attention in the literature. Almost all possible types of disturbance of the structures of this region have been reported. The typical cases of “broken neck,” with characteristic local signs and symptoms, and a neurological picture of cord compression, are easily recognized although, unfortunately, these often fall into the fatal group. In the less severely traumatized cases, in which the local signs and symptoms and the nervous manifestations occur with or shortly after the accident, the condition is suspected clinically, and usually the diagnosis is confirmed by the roentgen examination. There is, we believe, a type of fracture-dislocation in the upper cervical vertebrae which has not been emphasized in the literature. These cases present obscure, slowly progressive neurological signs and symptoms years after the trauma. At the time of the injury local signs and symptoms are absent, insignificant, or they rapi...

THE KLIPPEL-FEIL SYNDROME

Hitherto, reports of cases of the Klippel-Feil syndrome have considered only the clinical manifestations. These have been described as shortening of the neck, low hair line, limitation of movements of the head, abnormal associated or mirror movements, clumsiness of the hands, disturbances of deep sensation in the hands and forms of ocular palsy, affecting chiefly the third cranial nerve. Roger, Arnaud and Audier1discussed the nervous manifestations associated with the Klippel-Feil syndrome, reporting an instance of their own and reviewing in detail the cases reported up to 1934. The following case is described, because pathologic reports on the changes in the spinal cord are lacking. REPORT OF A CASE History. —A deformed, full term girl (fig. 1) was delivered from a primipara aged 20, who had had a profuse vaginal discharge during the entire pregnancy and toxemia of nephritic origin in the last trimester. The general appearance of the

The Nervous and Mental Manifestations of Myxædema. (Irish Journ. Med. Sci., No. 111, p. 124, Mar., 1935) Parker, H. L.

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The nervous and mental manifestations of myxcedema

The nervous and mental manifestations of myxcedema

NEUROLOGIC MANIFESTATIONS OF HYPERINSULINISM AND OTHER HYPOGLYCEMIC STATES

The neurologist so frequently is confronted with diagnostic problems involving bizarre nervous symptoms that he should acquaint himself with syndromes which may have as a predominating symptom some nervous manifestation, although the underlying disease may be outside his special field. Hyperinsulinism and hypoglycemia are conditions of this type, and, although not primarily of neurologic importance, the presenting symptoms may be of a distinctly nervous character. Symptoms from both overactivity and underactivity of the endocrine glands generally have been recognized. Thus both exophthalmic goiter and myxedema have been attributed to the thyroid gland for many years. For some unknown reason, however, the recognition of symptoms resulting from the overactivity of certain glands has lagged behind the recognition of the symptoms of underactivity. Diabetes, parathyroid tetany and hyposuprarenalism (Addison's disease) were described long before hyperinsulinism, hyperparathyroidism and hypersuprarenalism. We are limiting this paper to conditions that are the antithesis of diabetes, in