The pathology of ophthalmoplegia / by W.J. Collins and L. Wilde.

  • Collins, William Job, 1859-1946.
Date:
1891
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Licence: Public Domain Mark

Credit: The pathology of ophthalmoplegia / by W.J. Collins and L. Wilde. 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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    sinus. Putting aside the rather obscure ocular i3a]sies of cortical origin the floor of the aqueduct of Sylvius and fourth ventricle and the walls of the cavernous sinus would be the most favorable site for small lesions to effect large results; in the former such lesions would be mostly nuclear, in the latter necessarily neural. We would here introduce the following scheme: Ophthalmoplegia . f conjugate deviation. I. Cerebral, (a) cortical \ hemi-ptosis (?). I hysterical ophthalmoplegia (?). {b) cortico-peduncular. (c) nuclear 3d nerve \. ilidoplegS } ophthalmoplegia interna. palsy of extra-ocular muscles, ptosis. 4th nerve 4. palsy of superior oblique. 6th nerve 5. palsy of external rectus. (d) radicular (and ? commissural). II. Basal. (a) region of pons (vi.). (b) peduncles (vi. iv. iii.). (c) cavernous sinus (vi. iv. iii.). (d) sphenoidal fissure. III. Orbital (including peripheral). Ophthalmoplegia of cortical or cortico-peduncular origin is usually conjugate, not unilateral; this is a corollary to the observation that movements, rather than muscles or nerves, are represented in the cortical colligation. The only exception to this rule apparently is that of ptosis occuring upon the opposite side exclusively to that of the cerebral lesion. (Landouzy.) In order to complete the cerebral classification of intra-cranial sites of possible lesions resulting in ophthalmoplegia, it is necessary to add the radicular, to include lesions intermediate between the superficial and deep origins of the various nerves concerned, and perhaps also com- misural. In addition to intra-cranial causes, there are those situate in the orbits, which logically should be made to include the so-called periph- eral lesions, which some authors would place in a separate category. It is diflScult to deny that in some cases of transient-ptosis, symmetrical cycloparesis, convergent asthenopia may not be of peripheral neuro- muscular causation; and it is certain that trauma may be productive of peripheral palsies, whether by extravasation or by more permanent sequelfe. With a view to elucidate from a clinical standpoint some of the ques- tions we have raised in what has preceded, we have been at some pains to collect and classify such available cases of ophthalmoplegia in Eng- lish literature as would lend themselves to such treatment. We have