Injuries of nerves and their consequences - Reflex Sympathetic ...

VARIETIES OP MECHANICAL INJURIES OF NERVES. 129
deep sleep to find that he has been Ijing upon his arm, or
that it has been resting under his head, or in some awkward
posture, owing to which the limb feels numb and
dead, or may even be insensible to touch. The lapse of
a few moments usually restores it to full feeling, after a
short interval of unpleasant prickling and formication.
There is
probably here both nerve pressure and interrupted
circulation. In rarer instances, permanent palsy has followed
the malposition, and this is most apt to occur in the
deep sleep of debauch.
Althaus* gives a case of this accident occurring to a
lady during confinement, and while under the influence
of chloroform. Her head rested so long on the left arm
as to cause, by pressure on the brachial nerves, paralysis
of certain muscles, with anaesthesia. It is interesting to
note
that there was also inflammation of the wrist-joint,
such as often follows wounds of nerves.
Usually the ai-m is the limb involved, but there are
said to have been examples of facial palsy caused by
pressure of the hand on the face in deep sleep. I have
met with no instances of this, either in the books or in
practice.
Many examples of partial palsies of the upper extremities
from pressure during sleep have come under my
notice. At first, both sensation and motion suffer, but the
motor palsy usually continues longer, and is more severe.
The most troublesome cases are those which arise from a
person having slept with one arm resting on the edge of
a settee. Two such cases appeared at my clinic recently.
In both there was hardly any sensory loss, but in both
there were exactly the same muscular troubles. The
flexors were perfect, but there was complete palsy of the
extensors of the wrist, of the first phalanges of the fingers
* Med. Electr ,
2d ed. London, p. 489.