A case of Landry's paralysis / by John Cowan, A. J. Ballatyne and D. MacDonald.

  • Cowan, John, active 1909.
Date:
[1909]
Catalogue details

Licence: In copyright

Credit: A case of Landry's paralysis / by John Cowan, A. J. Ballatyne and D. MacDonald. Source: Wellcome Collection.

Provider: This material has been provided by UCL Library Services. The original may be consulted at UCL (University College London)

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    Note on the Ocular Symptoms. history.—The patient stated that before the onset of her illness she could read without glasses, and carried on a dress- making business without any visual difficulty. About six clays before her admission, that is, a few days after the onset of her illness, she began to see double, and her friends noticed that she squinted. Up till the time of her admission she had not observed any defect in her visual acuity. Examination.—When the first complete examination of the eyes was made on 28th September (four days after admission), the general condition of the patient had already begun to improve. The conditions found were as follows :— The right-sided facial paresis involved the orbicularis palpebrarum, causing slight inequality of the palpebral fissures (right fissure larger than left), and practical absence of winking on the right side. Voluntary closure of the lids was possible on both sides, but was not so firm on the right side as on the left. The absence of winking in the right eye had led to lachrymation and irritation. The right pupil was dilated to a slight extent, and did not contract either on illumination or in near vision. The left pupil was also inactive to light, but contracted in near vision. Movements of the right eye were markedly impaired, the most obvious defect being a limitation of dextrorotation, but deficiency of Isevorotation, elevation, and depression were also noted. There was also limitation of lsevorotation in the left eye. These facts, considered in conjunction with the fields of diplopia, apparently indicated paresis of the four recti muscles on the right side (especially of the rectus externus), and of the rectus externus on the left side. The faculty of convergence was unimpaired. Accommoda- tion was active throughout. Visual acuity was somewhat defective in the left eye (jV), and still more so in the rights). The ophthalmoscopic examination showed relative pallor of the right optic disc. There was also slight pigmentary disturbance round the disc and in the neighbourhood of the macula, but these changes had apparently no connection with the visual defect, since they persisted after the latter had gone. From the date of this first examination there was a steady improvement in the eye symptoms. Three days later up and down movements of the right eye were normal. On the 8th October the only affected muscle was the right external rectus, and this also steadily improved, although it was stdl slightly defective at the time of her dismissal on 6th December.