Note of a new form of pseudo-paraplegia / by T. Grainger Stewart.

Date:
1875
Catalogue details

Licence: Public Domain Mark

Credit: Note of a new form of pseudo-paraplegia / by T. Grainger Stewart. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

    7/12 (page 5)
    over the lumbar region elicits complaint of some degree of tenderness. The hot sponge elicits nothing peculiar. The bones and joints are normal. The muscles are in all parts well nourished. In both legs, also apparently in the right hand, voluntary effort at movement, or peripheral irritation induces spasmodic contraction of all the muscles, so that the limb becomes rigid, as above described. There is no tendency to cramp. After prolonged exertion jerking of the muscles is noticed, but it soon passes off. There are no fibrillary twitch- ings. Electro-sensibility and electro-contractility are normal. The peculiar features of this case are, the almost perfect soundness of the sensory functions, and tbe undue excitability of the motor structures, whereby in the affected regions general contraction is induced, either by attempts at voluntary move- ment, or by peripheral irritation. These features do not correspond to anything which is described in the works on diseases of the nervous system to which I have access. It is sufiiciently clear that, although the patient is virtually paraplegic, he is not really so, seeing that the power of muscular contraction is impaired in no part of the lower limbs. It is therefore among the pseudo-paraplegias that we must look for analogous cases. In M. Jaccoud's classical work, Les Paraplegics et I'Ataxie du Mouvement, there are described five forms of pseudo-paraplegia, viz.:— 1. A result of general asthenia, which is essentially cha- racterised by the debility being as marked in the arms as in the legs, and by all normal movements being performed, although feebly. 2. A result of partial paralysis—that is, of paralysis of individual muscles or groups of muscles. 3. A result of exaggerated spinal excitability. In this form walking is embarrassed or rendered impossible, because contact of the sole of the foot with the ground induces more or less violent reflex movements, it may be either in the extensors or the flexors. This, of course, induces singular jerkings, which interfere with progression. When fully developed it cannot be confounded with paraplegia, because the limb is agitated by movements, sometimes painful, each time that the foot touches the ground ; but when it is present in a less degree error is possible, walking being simply rendered difficult or irregular by the sudden contraction of a group of muscles which inter- feres with the- series of movements necessary for normal pro- gression. If one watches closely, however, the nature and cause of the interference with walking are evident. If the mode of walking does not clear up the case, directing the patient to move in bed infallibly does so ; for the movements of the leg are perfectly normal so long as the foot is not touching tlie ground. This variety was described by M. Goupil as a form of hystericai