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A Case of Syringomyelia - pdfs.semanticscholar.org CASE OF SYRINGOMYELIA By ABINASH CHANDRA DE,...

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A CASE OF SYRINGOMYELIA

By ABINASH CHANDRA DE,

Assistant Medical Officer, Rajgarhali Tea Estate, Makum Junction, P. O. Assam

On 28th July, 1942, Lalua (M.), aged about 30, a

labourer of this Estate applied for treatment in respect of recurring attacks of vesicular eruptions on the outer half of right hand during the last 6 or 7 weeks. History of present condition.?He at first noticed one

day on the thenar eminence of the right hand one

small papule which rapidly enlarged into a vesicle and in three or four days' time burst leaving a raw ulcerated surface which healed up spontaneously after about a

fortnight. The vesicle and the ulcer so formed were practically painless and devoid of sensation. Another vesiclc appeared on the palmar aspect of the terminal

phalanx of the right thumb and about four days later a third of the same kind and character appeared at the back of the same thumb. These two did not burst.

Previous history.?About three years previously he had a similar trouble when three or four such vesicles with subsequent ulceration and sloughing appeared, one after another, affecting mainly the index finger of the right hand the terminal phalanx of which had been permanently flexed and rendered stiff resulting in a

/marked deformity (claw-finger). There was no percep- tion of sense or feeling of pain over the affected area. Simultaneously with the affection of the index finger two more vesicles appeared over the left knee joint which also behaved exactly in the same way as the

other ones;and left scars after healing. There was no history of injury affecting the spine,

shoulder or hip joints; of syphilis; of paralysis; or oi

any other nervous affections.

There was nothing of importance in the family history.

Investigations : (a) General symptoms, bleep, memory, intelligence normal. Vague pains present in

the muscles of hands and legs. .No headache, no fever. Vision good, pupils equal, accommodation normal, no squint or nystagmus. .N o defect in speech, no tremor of lips and tongue. Hearing good. No enlargement of spleen or liver. Heart and lungs apparently normal.

(6) Muscular system.?No weakness or paralysis. No alteration of gait. Mild muscular spasm over the left

252 THE INDIAN MEDICAL GAZETTE [June-July, 1946

knee joint. No muscular atrophy anywhere except in the affected index finger and partly on the thenar eminence of the right hand.

(c) Deep reflexes.?Knee jerks normal. Ankle clonus absent. Triceps reflex, supinator jerk, wrist jerk- anterior and posterior?all feeble in the right hand.

(d) Superficial reflexes.?Babinski sign absent, con-

junctival, abdominal and cremasteric present. Sphincter reflex normal.

(e) Common sensations.?Pressure sense present. Touch, pain, thermal and cold senses all lost : (i) Over the radial half of the right hand both anteriorly and posteriorly and continued above up to about middle of the forearm both in front and back. (ii) Over the lower half of left thigh extending below up to the patellar tendon both in front and outer side (vide diagram).

(/) Trophic changes.?Skin and muscle atrophy present on the right index finger and right thenar eminence. Erythema, ulceration, sloughing nil. Vesicles present as aforesaid. To sum up the result of investigations, the following

principal features lead to the diagnosis : (i) The pain- less vesicles and ulcerations and their distribution; (ii) loss of thermic impressions and other common

sensations over particular areas; (Hi) a certain degree of atrophy caused by muscular and skin wasting in the affected parts; (iv) the anaesthetic areas and their relations to the spinal segments in the cord (see dia- gram), and (v) a chronic course.

Diagnosis.?Such combinations of signs and symptoms are not to be found in any other nervous affections except in the rare condition of syringomyelia. The lesion is in the 7th and 8th cervical, and 2nd and 3rd lumbar segments.

Differential diagnosis.?(a) '

Progressive muscular

atrophy' has no impairment of sensations; (b) 'Hyper- trophic cervical meningitis

' has severe pain which was absent in this case, and in (c)

'

Multiple peripheral neuritis' the symptoms are more scattered and there is no loss of thermic sense.

My thanks are due to my chief Dr. S. L. Slaughter. M.R.C.S., who first drew my attention to the case and

encouraged me to investigate the condition and report. [Note? A follow-up of this .case and_ exclusion of

leprosy would be of interest. Organic diseases of the nervous system which cripple and kill in Europe do not thrive in India, as a rule.?Editor, I.M.G.]

Diagram showing the areas where common sensations are lost and their relations to the corresponding seg-

ments of spinal cord.

C>!k Cervical

w 7ft Cervical \ 2nd. Lumber

3rd Lumbar

Diagram showing the areas where common sensations are lost and their relations to the corresponding seg-

ments of spinal cord.


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