Neuralgic pains of long continuance are not infrequent accompaniments of hemiplegia, and may be lasting even after nearly complete recovery from the paralysis. A peculiar restlessness, a constant desire for change of position, has been referred to derangement of the muscle-sense. It is sometimes very distressing, and causes much annoyance to attendants as well as to the sufferer, as the patient is no sooner placed in one position, no matter how comfortable, than he desires to change it.
The mental condition seldom fails to suffer more or less in cases of hemiplegia, but the limits are very wide between a slight emotional excitability on the one hand and almost dementia on the other. This is, of course, applicable to cases where the lesion is a single or limited one, and not where a hemorrhage or thrombus is merely a part of a general vascular degenerative change with chronic meningitis or atrophy of the brain, where the mental decay can hardly be called the result of any single lesion. In cases of aphasia the mental condition is harder to make out, from the peculiar inability to communicate ideas if present. It is very safe to say, however, that many such patients possess much greater intelligence than would appear to a casual observer, and yet the apathy with which they often bear the deprivation of speech and consequent isolation speaks more strongly in favor of some blunting of the perceptions than of Christian resignation. A patient whose general appearance is that of tolerable comfort is likely to cry when attention is called to the helpless condition of the hand. It is probable that memory suffers in such cases, if not the reasoning faculties.
Trousseau cites the case of Lordat, who became aphasic, and after recovery described his own case. The learned professor claims to have been in full possession of his faculties, and to have arranged a lecture with the divisions and subdivisions of the subject, and all this without the thought of a single word passing through his mind. Trousseau ventures to doubt the possibility of carrying on complicated mental processes without words, and thinks Lordat may have overestimated the precision of his mental processes. It appears in confirmation of this view that after his attack he always read his lectures, whereas before he had been distinguished as an extempore speaker.
McCready, in an excellent article in the New York Journal of Medicine (September, 1857), discusses this subject at length, and details a number of cases where it was evident that paralytics and aphasics (who, however, he did not know by that name, nor the special lesion connected with their condition) possessed not only ordinary intelligence, but excellent business judgment and ability. He says that the confusion of mind and difficulty in pursuing a train of thought of which apoplectics are apt to complain is, to a great extent, the mere result of diminished nervous energy—that they comprehend well and judge correctly. It is fair to say that while the mind is almost certainly impaired, it is not necessarily in exact proportion to the severity of other symptoms, aphasia included. The memory, either special or general, is most apt to be impaired.
The testamentary capacity of a person who has had an apoplectic fit or who is paralyzed at the time of making a will may be called in question. The only general remark to be made is that these facts alone are not sufficient to prove incapacity; neither should the presence of aphasia or agraphia do so without further evidence of want of comprehension of the meaning of language used by others; so that if, for instance, a person were seized with hemiplegia and aphasia between the drawing up of a will and its signature, it should not be invalidated unless there be further evidence to show that the testator was incapable of understanding it when read over to him. In cases of word-blindness, a patient, like one described by Magnan, may be able to draw up a will with full comprehension of what he is doing, and yet be unable to read it understandingly. Inability to signify intelligibly assent or dissent would, of course, entirely disqualify one from signing a will.
It is seldom that a paralytic attack fails to leave its mark, though perhaps slight, for years, if not for the remainder of life. An extreme ease of shedding tears is a very common symptom, and sometimes laughter comes on very slight provocation.
Among the most interesting groups of phenomena connected with hemiplegia, and sometimes the sole representative of this condition—that is, existing alone without any motor paralysis—is that embracing the means of communicating with the outer world by means of language spoken or written. Corresponding to, and usually but not always connected with, right motor paralysis we have the inability to use words in speaking, known as aphasia, aphemia, alalia, and others. The first of these names is the one most frequently used. Agraphia is the inability to use words in writing.
On the receptive side we have the inability to understand language as presented to the eye (word- or psychic blindness) or to the ear (word- or psychic deafness). A case of the former condition has already been spoken of. One still more singular was reported by Mdlle. Skwortzoff,37 where the patient, not being blind, could not understand letters presented to the eye, but could read with the fingers and understand raised letters like those used by the blind. In a case of the latter kind a man whose ears were normal, and who could distinguish different sounds, answered questions, but entirely at random, though he could read and understand what was written. All these defects are manifestly connected with a peculiar loss of memory, and hence the word amnesia is used sometimes to cover part of the group, and amnesic as an adjective to qualify aphasia.
37 Comptes Rendus de la Société de Biologie, 1883, p. 319.
It should, of course, be understood that the muscles are not paralyzed, so that glottis, lips, tongue, and fingers are capable of making the necessary movements to produce words, and, on the other hand, that the senses of sight and hearing are intact. Aphasia was confounded by some of the older writers with paralysis of these organs, and the whole grouped together under the name of alalia. Even now the distinction is not always clearly observed.