TABLE OF SYMPTOMS IN CROSS-LESIONS OF THE CORD.-(Continued.) Paralysis of all muscles of Psoas. lower extremity except psoas. Total paralysis of whole lower extremity, psoas included. 22 XII-III. Dorsal. Paralysis of lower extrem ity, and gluteal region. Paralysis of abdominal and dorsal regions gradually added as the site of the lesion ascends. Paralysis of muscles of respiration | In complete lesions | Increased in in causes diaphragmatic breathing and dyspnea. epigastric reflex complete lesions. and abdominal Patellar. reflex may be Cremasteric. abolished. Achilles. All muscles of trunk and lower extremities. Oculopupillary symptoms. All below lost in IV-I. Scapular. Tendon reflexes of paralyzed cles. mus All below lost in complete cord division. All below increased. Rib Total cross-lesions from the fourth cervical segment upward are rapidly fatal, because of complete paralysis of the diaphragm and intercostals. Disease of the posterior horn is marked by sensory disturbance or anesthesia in a given area, such as follows a lesion of the posterior column. Lesions of the posterior roots cause anesthesia if complete; hyperalgesia and radiating pain if irritative. Lesions of the anterior roots produce the same results as lesions of the anterior horns. Lesions arising within or immediately about the central canal, as in syringomyelia, produce a peculiar dissociation of touch sensations, so that painful and thermal impressions are not properly recognized while tactile or contact impressions remain practically unaffected. Joint dystrophies are often added. A lesion that divides one lateral half of the cord gives rise to the Brown-Séquard syndrome (see p. 51). In many cord diseases two or more physiological divisions are symmetrically affected. In amyotrophic lateral sclerosis we have, added to the rigidity, myotatic irritability, and contractures that mark disease of the lateral tracts, a progressive muscular atrophy that is due to the lesion of the anterior horns. Ataxic paraplegia is marked by symptoms in both the lateral tracts and the posterior columns, and we find ataxia and rigidity with weakness variously combined. The following table roughly shows the relation of the various cord diseases to the physiological division of the cord. Those which are marked by lesions confined principally to given tracts in the spinal cord are denominated system diseases, as distinguished from indiscriminate lesions. As will appear in the consideration of individual diseases, some of these cord lesions, as in locomotor ataxia, are only a part of the morbid findings. |