Section of Neurology 31
High narrow palate. Supernumerary digit on each foot; small sessile mass growing fron
base of fiftn digit of left hand.
Vi8ion.-He can only perceive light and hand movements. Retinitis pigmentosa, with
changes most marked in the macular regions. Optic discs: arteries small, but otherwise
normal.
No evidence of organic disease in central nervous system. Psychical condition: apathetic;
his answers to questions are variable in time and substance. Attention poor. No true
dementia. X-ray of skull: sella turcica normal in size and appearance. Wasserniann reaction
(blood) negative. No glycosuria.
A Case of Facial Hemiatrophy: Lack of Development of the
Breast on the same side.
By J. P. MARTIN, M.D.
PATIENT is a woman, now aged 20, in whom right-sided facial hemiatrophy comlllenced
at the age of 15. The right breast has nev-er developed, and there is now a deficiency of
subcutaneous tissue on the right side of the chest extending down to the bottom of the
pectoralis major muscle.
A Case for Diagnosis (Probably a Variant of Charcot-Marie
Progressive Neurotic Amyotrophy-Peroneal Type of Tooth).
By J. P. MARTIN, M.D.
History.-Female, aged 13, was well till eighteen months ago, then she suffered from
ichthyosis on the forearms. In the spring of 1924 she had four or five fits during a period of
about three months: in these fits she became rigid and her head was drawn back: she did
not "struggle" and did not lose consciousness.
Soon afterwards her hands began to waste.
The family doctor reports that an elder brother of the patient suffered from a similar
disease: his illness began with ichthyosis, then his hands wasted; afterwards his lower limbs
became spastic. He was sent to a hospital in Nottingham where he died. A post-mortem
examination was held. The doctor was informed that death was due to caries of the cervical
vertebre.
Exanmination.-Wasting of hands. Slight weakness of dorsiflexion at the right ankle.
Otherwise no loss of power. Reflexes all normal. No sensory loss. No changes in cranial
nerve functions.
A Case of Tabes Dorsalis.
By N. L. LLOYD, L.R.C.P., M.R.C.S.
F. D., AGED 41. 1912: syphilis. 1921: had a tired feeling, especially in the calves of the
legs after a day's work. Occasional stabbing pains in knee-joints.
March, 1922: Pupils A.-R., right larger than left. Ptosis of right eyelid. Vibration
diminished over sacrum. Deep reflexes all present. Plantar reflexes not obtained. Cerebro
spinal fluid, cells 54 per c.mm., protein 004 per cent. Wassermann reaction strongly positive
in cerebro-spinal fluid and blood.
October, 1922. Feeling less tired. Typical lightning pain in calves. Right pupil dis-
placed slightly inwards. Both pupils slightly irregular. Right plantar reflex unobtainable.
Left flexor. Ankle-jerks absent. Vibration sense diminished over external malleoli and
sacrum.
March, 1923: Pupils A.-R., both displaced inward, right larger than left. Cerebro-
spinal fluid, cells 9 per c.mm., protein 0045 per cent. Wassermann reaction positive in
cerebro-spinal fluid and blood.
February, 1925: Pupils fixed to both light and accommnodation, right larger than left.
both irregular and eccentric. Knee-jerks, right brisker than left; ankle-jerks, right absent,
left present but weak. Cerebro-spinal fluid, cells 13 per c.mm., protein 0025 per cent.
Wassermann reaction still positive in cerebro-spinal fluid and blood. Gait normal. Sensation
unimpairecd.
Ju-N2 *
32 Lloyd-Wyllie-Critchley-Turner
He has been treated energetically for three years, receiving about 20 grm. of novarseno-
billon intravenously, as well as mercury and iodide by mouth. During this time the ankle-
jerks became lost, but one has now returned. The Wassermann reaction in the blood
and cerebro-spinal fluid has remained " strongly positive." He is still able to walk twenty
miles a day.
Case of Myoclonus Epilepticus.
Shown by W. G. WYLLIE, M.D. (for ROBERT HUTCHISON, M.D.).
H. W., AGED 1 year eight months, has "for several weeks " had attacks of twitching
of the limbs, trunk, head and face, almost continuously when awake.
He was born at full term, sat up at six months, but makes no attempt to walk, and is
backward in speaking.
Family History.-Mother a very nervous woman. Maternal grandmother in an asylum
with dementia and chronic epilepsy. There is one other child, 3 weeks old.
In the attacks there are clonic movements of the arms and fingers, legs, head, eyes and
eyelids, and lips. Consciousness is usually retained, and the child may continue to smile
or to feed hinmself. In the more severe attacks the child's head gradually sinks down
forwards, almost touching his feet, and the eyes assume a vacant look, as seen in
petit mal.
Case of Post-encephalitic Myoclonus and Tachypncea.
By MACDONALD CRITCHLEY, M.D. (for JAMES COLLIER, M.D.).
E. S., A BUTCHER boy, aged 19. In March, 1924, had an attack of epidemic encephalitis,
characterized by insomnia, delirium and myoclonus of the shoulder miiuscles. The patient's
recovery was never complete; he became dull in mentality. Insomnia gave place to lethargy,
and the twitching of the muscles persisted.
His present state is one of mild Parkinsonism. There is definite myoclonus in the upper
halves of both trapezii, and to a less degree in the pectoralis, deltoid, biceps, and triceps of
the left side. The upper bellies of the recti abdominis also show myoclonus. These move-
ments cease during sleep.
The respiration is rapid (40 per minute), and each inspiration synchronizes with the
myoclonic jerk. The breathing is noisy, especially during sleep. The tachypncea, which
persists throughout day and night, is not accompanied by any thoracic distress.
Case of Post-encephalitic Contractures and Paroxysmal
Tachypncea.
By MACDONALD CRITCHLEY, M.D. (for JAMES COLLIER, M.D.).
I. C., FEMALE, aged 23. Last June was attacked with acute epidemic encephalitis
(diplopia; delirium). Patient has never made a complete recovery from this illness.
Gradual onset of Parkinsonism. Patient states that ever since last June her right hand
has been contracted. At present the right hand is claw-like in attitude. Feeble flexion is
possible, but extension is impossible. The right elbow is also contracted and cannot be
extended past a right angle. The left elbow cannot be extended to more than 120 . Both
legs are fixed in extension and the feet are drawn up in an exaggerated pes equinus attitude.
Patient's respiration is normal during the waking state, but when asleep the breathing
becomes faster (38 per minute), regular, and shallow.
A Case of Migraine.
By W. ALDREN TURNER, C.B., M.D.
FIVE years ago patient became subject to severe headaches: on one occasion this was
followed by transient hemianopia. For the past twelve months has had a series of sensory
attacks, affecting the right side of the body. The attacks commence with a sensation of
helplessness followed by pins and needles in the right hand. This sensation then passes