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

DIAGNOSIS AND PROGNOSIS OF INJURIES OF NERVES. 223
which have been lately shown to attack in such cases the
peripheral nerve trunks. Perhaps the facts, as to nongrowth
or lessened growth of the nails in cerebral palsies
which I have recently pointed out, may aid in doubtful
diagnosis. On the other hand, very soon after any grave
peripheral nerve lesion, there is sure to be great
loss of
power in the muscles to respond by movement to faradaic
These
currents, and, a little later, to the galvanic currents.
facts will usually enable us to separate cases of cerebral
palsy from those the origin of which lies below the brain.
I was consulted lately in regard to a lad}-, aged fortythree,
who, four years before, had a slight left hemiplegin,
the recovery from which was unusually complete. A few
weeks since she began to suffer from numbness of the left
foot and followed leg, by increasing and rapid loss of
power to flex the foot. Her attendant suspected a return
of the cerebral disorder, but on electricallj- examining the
peroneal muscles they were found to have lost power to
respond to the battery. We then insisted upon a vaginal
examination, when she was discovered to have a large
growth behind and to the left of the womb, and of a
somewhat suspicious nature. The local palsy was probably
due to this mass.
The differential diagnosis of spinal disease from peripheral
lesions presents greater difficulties, and is more apt
to give trouble than any of the other questions I have
mentioned. Given a case of numbness and partial paralysis,
is it due to nerve disease or to some spinal alteration
? If the former, it will probably, but not surely, be
unilateral ;
and if the latter, it will be likely to be bilateral,
and to affect both feet. For example
: if the
cause should be one affecting only a limited region of
the spine, the lower ganglia being
left unaltered, the
muscles will retain their electric irritability,
which is not
the case when these lower portions of the spine become