R. H. Cunningham
1909 Journal of Nervous and Mental Disease  
The patient was a woman, 54 years old, whose father died of old age. Her mother, after two paralytic strokes, was demented for ten years and died at the age of 74. This patient enjoyed good health up to the age of ten or twelve years, when she had an attack of typhoid fever. During the second or third week of this attack a paralysis of the right forearm and hand developed, and for several weeks following the attack the wasting of the affected muscles became very prominent. After several months,
more » ... ter several months, some of the paralyzed muscles began to improve, and continued to do so during the following two or three years. From that time until about one and a half or two years ago, the condition of the arm remained unchanged. For the past year or so the patient thought she could not use the hand quite as well as formerly and that it had become weaker, although its appearance had not perceptibly changed. On examination there was found atrophic paralysis and paresis of the muscles of the right forearm and hand, with glossy skin and vasomotor dilatation in the skin of the hand. Both knee jerks were lively, the right much more so than the left. The right palpebral fissure was narrowed, and the eyeball retracted. The right pupil was smaller than the left and did not dilate as actively or widely as the left. Taetile sensibility was diminished along the inner side of the arm, forearm, palmar surface of the hand, and over the scapula below the spine. The pain sense was very much diminished along the inner side of the arm, forearm and hand. The temperature sense was practically lost over the scapula and the inner posterior and inner aspect of the arm, forearm and hand, excepting over the thumb, the index finger and the outer half of the middle finger. This combination of atrophic paralysis and dissociated sensation evi¬ dently indicated that the patient had a unilateral lesion affecting the gray matter more or less profoundly in the lower part of the seventh cervical, the eighth cervical, the first dorsal, and the upper part of the second dorsal segments of the cord. If we carefully considered the history of this patient, it was very probable that during her attack of typhoid fever she developed a limited area of central myelitis, or a thrombosis of the terminal branches of several of the anterior spinal arteries, with subse¬ quent destruction of the gray matter of one side of the cord. For about forty years this uncommon lesion had been dormant, although it was evident from what the patient said that certain non-progressive sensory disturbances had been continually present. During the past two years, however, she thought the whole arm was becoming weaker; hence, the 287
doi:10.1097/00005053-190905000-00005 fatcat:3m2uajat4jdodjiunxoohuls44