Medical diagnosis ; special diagnosis of internal medicine : a handbook for physicians and students by Leube Wilhelm von 1842- & Salinger Julius L. (Julius Lincoln)

Author:Leube, Wilhelm von, 1842- & Salinger, Julius L. (Julius Lincoln)
Language: eng
Format: epub
Tags: Diagnosis
Publisher: New York : D. Appleton
Published: 1904-11-24T05:00:00+00:00

TABES DORSALIS [LOCOMOTOR ATAXIA]

GRAY DEGENERATION OF THE POSTERIOR COLUMNS—LEUCOMYELITIS

—POSTERIOR CHRONICA

Tabes dorsalis represents one of the best and longest-known partial affections of the spinal-cord substance, running a chronic-progressive course. The anatomical basis .of tabes depends, in the main, upon a degeneration of the posterior columns, which, as Leyden recognised first, occurs in connection with disease of the sensory-root fibres, so that a degenerative process in the spinal cord takes place which follows the course of these tracts in a centripetal direction. The most important clinical signs of the affection, dominating the morbid picture, are disturbances in the sensorij sphere and the ataxia.

The diagnosis in the majority of cases is easy, in that a certain complex of symptoms is almost pathognomonic of tabes. Difficulties can only arise in the very first stages of the disease, and occasionally in the later stages, if the typical picture of tabes becomes greatly modified, or the result of phenomena which are due to the development of the anatomical changes beyond the usual frame of the affection takes place, this causing the typical picture of the affection to be more or less altered.

Diagnosis of the First Stage of Tabes. — Incipient tabes can be diagnosticated as soon as lightning-like (so-called lancinating), paroxysmal pains, in the small of the back and in the lower extremity, occur, and the tendon reflexes are absent. These symptoms may exist for years without giving rise to ataxia; in spite of this, as the results of autopsies teach us, in such cases a typical degeneration of the posterior cord may exist. To these two initial symptoms usually a third symptom is added, disturbances of the movaMlity and in the width of the pupils, this being a reflex rigidity of the pupil (in about one half the cases, also, even if rare, total, i. e., affecting accommodation as well as reflex conditions), narrowing (myosis) and inequality of the pupils. In reflex rigidity of the pupil, the pupils are usually more contracted than normal, reacting however still to accommodation, but not to the influence of suddenly appearing light (Arygll-Robert-son phenomenon). The cause of these pupillary changes has not yet been definitely determined, especially as to whether they are of spinal or cerebral origin (arising from the region of the corpora quadrigemina), influencing the pupil reaction.

Eye Symptoms in Tabes. —Rarer than these three usually combined initial symptoms in tabes, there occur in the first stages of the disease affections of the nerve of sight and the muscles of the eye, which may occasionally even precede the just-mentioned spinal phenomena and that for a long time. For this reason, the diagnostic rule must be adhered to, not only in the later stages of tabes in which the diagnosis does not usually give rise to difficulties, but in every suspected case the mus- ■ cles of the eye should be examined for paralysis and especially also the function of the organ of sight should be determined and an ophthalmoscopic examination made. The findings which are noted in tabes

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