Anterior poliomyelitis. Extreme flexion deformity at the hips, inducing quadrupedal locomotion. (Gibney.)
Anterior Poliomyelitis.
—Anterior poliomyelitis is an acute inflammation manifested especially in the gray matter of the anterior cornua of the spinal cord, involving both the neuroglia and the cells, producing atrophy of the same and consequent paralysis of muscles supplied by the motor nerves. It may assume an acute febrile type, with rapid onset of paralysis, or it may be of slower development. Usually conceded to be of infectious origin, it still lacks the minute explanation for many of its attendant phenomena. It may appear with acute symptoms, febrile and convulsive, paralysis appearing more or less promptly. With the subsidence of other serious symptoms this paralysis remains. There may then be a period of partial improvement in the muscular condition, with disappearance of some of the most pronounced phenomena. Finally with the growth and development of the child more expressions of damage remain, and produce various distortions and deformities, varying with the muscle groups affected. Not only do deformities result, but there is more or less arrest of development, with disproportion in size between the limbs involved and those which have been spared. It is the early paralytic features which may permit diagnosis to be made in the early days of the acute febrile attack.
Cerebral Palsies.
—The cerebral palsies, so called, are the result of hemorrhages or acute disorganization of the brain. The former are usually unilateral and give rise to a corresponding hemiplegia, with either paralysis or spastic rigidity, and usually with atrophy. The paralysis may not be complete, but is rather of the paretic type, involving the entire limb, the reflexes being increased and the muscles stiffened rather than flaccid, with loss of electrical reactions.
A paraplegia points rather to lesion in the spinal cord and hemorrhage than to cerebral lesion. Transverse myelitis is rare in children. Multiple neuritis may produce somewhat similar effects, as may also the toxic paralyses due either to drugs (especially lead or arsenic) or that following diphtheria, in which case it is the muscles of the throat and neck which are likely to be involved. [Figs. 274] and [275] portray extreme types which are rare, but instances of minor degree of affection are frequent.
Fig. 275
Anterior poliomyelitis. Duration seven years. Showing atrophy and slight lateral curvature of the spine; two and a quarter inches of shortening. (Whitman.)