Oculomotor paralysis accompanied by facial palsy, neuroparalytic keratitis and hemiplegia / by Burton Chance.

  • Chance, Burton Kollock, 1868-1965.
Date:
1909
Catalogue details

Licence: In copyright

Credit: Oculomotor paralysis accompanied by facial palsy, neuroparalytic keratitis and hemiplegia / by Burton Chance. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    and soon became sparkling. The ulcerous area rapidly became sharply outlined. In a few days, on forced effort, there was slight ability to raise the upper lid, but no effort could overcome the paresis of the internal rectus, though there was a faint reaction of the super- ior oblique muscle. By September 21 the ball remained divergent and fixed at the outer extremity. Facial paralysis was complete on the left side, and in the distribution over the superior and inferior maxillary branches of the fifth nerve there was anesthesia. The cornea continued hazy and anesthetic. About this time the patient’s left arm and leg became numb and powerless. She was seized suddenly in the night in the midst of a severe headache; in the morning she could not lift her arm nor raise her leg in walking. On September 28 the patient was sent to Dr. Wm. G. Spiller, at the Polyclinic hospital, for an examination of her general state. His letter, dated October 12, reported that the patient had cerebral syphilis. On October 24 the solution of atropine was discontinued, and by November 11 the “mixed solution” which had been ordered three weeks before was withdrawn, and mercurial ointment sub- stituted. By November 28 the patient showed signs of ptyalism, and all medicines were withheld. Toward the end of December, when efforts were forcibly made the glotye could be brought to the vertical line, but not within the meridian, and when the exertions were made it was noticed that the palpebral fissure widened so that the globe was entirely uncovered by the lid. At this time marked increase in the general muscular power began; the facial palsy was reduced, and the leg and arm regained much of their lost functions. On January 5, 1906, the cornea again became denuded. To allay the irritation the lids were sealed with plaster and a firm band- age was kept on for two days; on the removal of this the exposed area was seen to be closed, but the surface was shaggy, as though it were studded with epithelial shreds like the remains of ruptured herpes. These shreds were examined by Dr. Goldberg and found to consist of epithelial cells only. Toward the end of the month the epithelium became restored. From this time on the return of power was marked. The ptosis disappeared almost entirely. The eye could be rotated to the primary position, but not within the vertical nor above or below the horizontal meridian. The woman could walk with greater comfort. A certain childishness manifested in the past gave place to a decidely acute intelligence. Before the first of February, 1906, the patient ceased her visits, and did not return again until January, 1909, in response to a letter from me. By this time she had regained all her lost weight and much more besides, for she weighed 215 pounds. In the past three years she had been able to keep house and to work as a laundress. She has had a constant dull ache over her left brow, and, wrhen overtired, she has attacks of headache, and the arm and leg feel like “pins and needles.” She is very much annoyed by diplopia when she attempts