PATHOLOGICAL ANATOMY.—The pathological changes taking place in the spinal cord of patients affected with unilateral spinal paralysis must vary in different cases according to the particular nature of the lesion giving rise to the characteristic symptoms. In those cases reported to have terminated by a gradual disappearance of the symptoms with or without therapeutic interference it is very probable that the exciting cause was a hyperæmia or a myelitis of a small portion of one lateral half of the spinal cord, sufficiently high in degree to impair the conducting power of the nerve-fibres passing through it. In some cases the myelitis may lead to a degeneration of the nerve-fibres, or even extend to the other half of the cord, and by calling forth additional symptoms render the case more complicated. In syphilitic cases the disease depends upon syphilitic deposits or neoplasms in the affected portion of the spinal cord; these cases, however, generally yield to treatment. In the same manner may circumscribed sclerosis give rise to the disease. Another cause may be found in the compression of the cord caused by meningeal tumors or by the fractured portions of some of the vertebræ. Chronic disease of the vertebral bones themselves (Pott's disease) may also, by encroaching upon the spinal cord, become an exciting cause.
The most typical cases, however, are those depending upon traumatic injuries, by which one lateral half of the spinal cord is forcibly divided. These lesions resemble in nature the division of the cord in the physiological experiments on animals, and are most frequently caused by a stab from a knife penetrating to the cord through the intervertebral spaces.
DIAGNOSIS.—In those cases in which the symptoms of unilateral spinal paralysis appear soon after an external injury to the spine, it becomes obvious that the latter is the exciting cause. In cases of a more chronic character, in which the symptoms appear gradually, the nature of the exciting cause can only be correctly determined by the observation of certain collateral symptoms characteristic of such causes as might give rise to the symptoms of the disease in question. As regards the diagnostic symptoms of unilateral spinal paralysis themselves, they are sufficiently characteristic to be easily distinguished from those of other forms of hemiplegia or hemiparaplegia. Thus, cerebral hemiplegia may be distinguished from the disease under discussion by the sensory disturbances being either absent or on the same side as the paralysis; furthermore, by the one-sided paralysis of the face and of the tongue and by the affection of various cranial nerves. The hemiplegic form of spasmodic spinal paralysis is distinguished by the absence of sensory disturbance, etc. Lastly, hemiplegia depending upon lesion of one side of the cauda equina is distinguished from unilateral spinal disease by the paralysis and anæsthesia being confined to the same side, and by generally affecting certain nervous districts of the lower extremities.
PROGNOSIS.—In unilateral spinal lesions the prognosis depends obviously on the particular nature and intensity of the exciting cause. On the whole, there are quite a number of cases reported, even of traumatic origin, which have terminated favorably.
TREATMENT.—The treatment of unilateral spinal paralysis depends, like the prognosis, upon the nature of the exciting cause. The principles upon which it is to be pursued of course are the same as those upon which the treatment of the various lesions causing the disease—such as hyperæmia, myelitis, sclerosis, wound of the spinal cord, etc.—is based.
PROGRESSIVE LABIO-GLOSSO-LARYNGEAL PARALYSIS.
BY H. D. SCHMIDT, M.D.