Involuntary movements may take place in limbs entirely incapable of voluntary ones, and may occur under conditions of excitement or with other involuntary movements, such as gaping. On the other hand, the patient often moves the well hand while making utterly ineffectual attempts on the paralyzed side. Involuntary twitching of the feet may be annoying. Reflex movements, especially of the feet, are often exaggerated, and in fact the twitching just spoken of is often excited by some trifling, perhaps unperceived, irritation. A touch with the point of a penknife upon the sole of the foot may call out a movement which the patient is utterly incapable of executing by the force of the will, and the appearance of volition is often increased by the grimace or exclamation of pain or annoyance.
Epileptiform attacks may be a sequence of hemiplegia, occurring at irregular intervals, and not of great severity. Sometimes the patient seems depressed or less talkative for a day or two previously, and relieved after the fit has occurred, as in true epilepsy.
Comparatively little attention has been given to the condition of sensation in hemiplegia. In the more complete apoplectic stupor it is apparently abolished, like nearly all the functions above those of respiration and circulation, but it often happens when the patient is unable or unwilling to make any voluntary response to the voice, and lies apparently perfectly indifferent, that any moderate irritation like a pinch will bring out evidence of sensation. It is often stated that in hemiplegia the sensation is not at all affected; and this is probably true of many cases, but a more attentive examination will often disclose a decided diminution on the affected side. Broadbent, who has tested with pricking, touch, the compasses, and hot substances, says that it is frequently diminished, and often greatly so, and not only in the limbs, but in the face, chest, and abdomen. Tripier34 says that a lesion of the larger part of the fronto-parietal region determines at the same time a paralysis of motion and a diminution of sensibility; and one may conclude that this region holds under its dependence sensitive as well as motor phenomena intimately connected with each other. The zone called motor, of which the limits are difficult to fix, may with more reason be called sensori-motor.
34 Revue mensuelle de Méd. et Chir., 1880, p. 18.
Anæsthesia probably in most instances disappears more rapidly than motor paralysis, which accounts for its being frequently overlooked. The more common location of lesions causing motor paralysis—i.e. the corpus striatum and the motor portion of the cortex—is one not likely, unless extensive, to concern sensation; but there are cases where a very complete hemianæsthesia, including the special senses, may be found; and when, in such cases, the motor paralysis is slight, a picture is presented almost identical with that of hysterical hemianæsthesia with great diminution or abolition of the special senses, hearing, taste, smell, with concentric diminution of the field of vision and of the color-field, or complete color-blindness on the affected side.
A man aged thirty-five while at work suddenly felt a prickling sensation upon his left side, and became unconscious. The bystanders say he was convulsed. On returning to consciousness after three hours he had lost his speech, which, however, was rapidly recovered, and his left side was not so strong as his right, though there was no distinct history of paralysis. Two or three days afterward it was noticed that sensation was much diminished upon the left side, two sharp points of the æsthesiometer being felt as one at two inches on the forearm and three-quarters of an inch on the tongue. He could feel the touch of a spoon, but could not tell whether it was cold or hot. Odors were not recognized upon the left side of the nose, except faintly ammonia and chloroform, and a watch was heard on that side only when in contact with the ear. The field of vision was much diminished and color-blindness was almost complete. A few days later the field of vision had increased, and there was color-sense, the field of perception for the different colors being arranged almost exactly as laid down by Charcot, vision for red being largest, but not so large as for simple perception of objects; those for blue, green, and yellow nearly the same and smaller; and that for violet limited to a small space in the centre of the field.
Less regular forms of anæsthesia may be met with, as well as hyperæsthesia. These are said to be especially connected with various lesions of the pons.35 A case is recorded36 of complete hemianæsthesia in a man, coming on like a blow. There was no loss of motor power; the face was symmetrical, sight and hearing unimpaired. Taste was lost and smell doubtful. There was aortic and mitral disease. Hughlings-Jackson speaks of a man who experienced a severe apoplectiform attack which it was thought would be fatal in a few hours. He recovered, however, with almost complete loss of hearing.
35 Conty, Centralblatt f. d. Med. Wiss., 1878, 571.
36 Med. Times and Gaz., 1871, i. 246.