Flascher18 has described a unique case of bilateral facial atrophy occurring in a woman twenty-three years old. When an infant she fell and injured her forehead, and soon afterward had an attack of measles without eruption. Shortly afterward the atrophy appeared. Tactile sensibility was diminished and the secretion of sweat absent. The masseter, temporal, and facial muscles and bones were atrophied. External strabismus of the left eye was present; the pupil of this eye was dilated, irregular, and non-reactile; sight was diminished, the optic disc atrophied. This case would appear to differ somewhat from true facial hemiatrophy. It was probably a peripheral nerve affection following measles.
18 Berliner klin. Wochenschr., 1880, No. 31.
Mitchell19 has reported a case of absence of adipose matter in the upper half of the body. I had an opportunity of examining this patient, who was exhibited at a meeting of the Philadelphia Neurological Society, and noticed that both sides of the face presented a striking similarity to the affected side in cases of unilateral atrophy. The muscles were apparently not affected. Mitchell suggests the possibility of separate centres capable of restraining deposits of adipose tissue.
19 Am. Journ. Med. Sci., July, 1885.
DURATION AND TERMINATION.—The disease pursues a slow but generally progressive course. In a few instances, after having attained a certain development, it seems to have remained stationary for many years. Nothing could better illustrate the slow progress or stationary character of this affection than the study which Virchow made in 1880 of a patient whose case had been described by Romberg more than twenty years before. After comparing the patient's present condition with that described in notes taken twenty-one years before, Virchow was not able to convince himself that any material alteration had occurred in the atrophic parts; in fact, he regarded the disease as having long ago become stationary. Cases reported by Tanturri, Baerwinkel, and others bear out the same view as to the stationary character of the affection in some cases.
COMPLICATIONS.—In a case of Virchow's, in addition to the facial atrophy the patient presented atrophy which, commencing in the distribution of some of the dorsal cutaneous nerves of the scapular region, affected the musculo-spiral nerve from its origin downward, most markedly in the forearm and head. Mendel20 describes a case of facial hemiatrophy occurring in a monomaniac, the diagnosis being complicated by the somatic signs of degeneracy—congenital facial and bodily asymmetry. The patient was twenty-eight years old, and the disease could be traced back to the seventh year. In several reported cases the disease has followed or has been associated with epileptic seizures. Buzzard21 has published a case in which the affection came on in a girl aged thirteen in the course of a second attack of chorea. In another it followed typhoid fever. In a case reported by Parry22 left hemiplegia with temporary disturbance of intelligence preceded the disease by about two years. In another, observed by Axman and Hueter, the patient, a man aged thirty-two, had suffered from irregular contractures of the left masticator muscle, which commenced in the seventh year. These spasms were associated with an increased delicacy of sensation in the region of the left trigeminus. Neuralgia is sometimes a complication. In a case reported by Holland,23 the patient for several years suffered from paroxysms of fronto-temporal neuralgia.
20 Neurologisches Centralblatt, June 15, 1883, quoted in Journal of Nervous and Mental Disease, 1883, x. p. 571.
21 Transactions of the Clinical Society of London, vol. v., 1872, p. 146.
22 Eulenburg.