A CLINICAL LECTURE on ASTEREOGNOSIS in TABES DORSALIS: Delivered at Prince Alfred Hospital, Sydney

G. E. Rennie
1903 BMJ (Clinical Research Edition)  
aged 3T, married, a fitter sheds, was admitted to Prince Alfred Hospital under 3rd, 1902. He complained of difficulty in walking, loss left hand, and some difficulty in micturition. Hle ill two years. He hadhad syphilis at the age of i8 years, heavy smoker since then but a total abstainer from State on Examination.-His intelligence is good, symptoms of mental disturbance. He has no headache, andis not subject to fits. The special senses are all good, and the fields of vision are normiial. The
more » ... are normiial. The pupils and react on conv-ergence but not to light. There is affection other cranial nerves. The muscles of the trunk and weakness or wasting. There is a slight degree of muscular gait is strained;he requires to keep his attention fixed enable him to walk steadily, and he cannot walk alung There is distinct Rombergism. His handwriting lie can only write a few words, and then has to stop Sensation.-Tactile sensation is fairly good over all exception of the ulnar side of the left forearm, hand, completely absent over the little finger of the recognize two touches or pricks made at different ie and hand at the same time as two distinct sensory the left hand is placed on his knee, with the palm upwards, recognize pressure made on the palm of the hand thuimb, he is being touched on the back of the hand. There the trunk about the level of the seventh dorsal nerve is rather mcre marked on the left side than on trunk analgesia extends for a distanceof 3 or 4 inches. some analgesia on the uluar border of the left arm, left hand. Elsewhere the painful sensation is is diminished over the left ulnar area and of this thermal anaesthesia being somewhat of analgesia. There is distinct impairment of sense. is unable to recognize the position of his flngers wh5ft moved. He is unable to place the finger accurately or bring the two forefingers into accurate apposition eyes closed. He is unable to distinguish between different in the two hands, the left hand being most at fault He is quite unable to i ecognize the nature of objects for example, he cannot tell the difference between match-box half-crown piece, nor can he recognize a knife, His sensation is good in the feet, and lie can placed on the sole of either foot-that Is, he can round or square, large or small. In the right nition of different objects is perfect. Reflexes.-His elbow-jerks, wrist-jerks, and knee-jerks absent; the cremasteric and abdominal are present; the response on both sides feebly. There is a delay imicturition, but no incontinence of either is loss of sexual desire. The combination Of symptom3 in this case clearly to the diagnosis of tabes dorsalis. CASE 1I Ilistory.-A. M., a single woman, aged rnitted to Prince Alfred Hospital under my care I9o0. complained of weakness of the knees, shooting staggering gait. Her symptoms had begun some these become aggravated during the last year or so. She monia eight years ago, but no other previous illness. o f acquired syphilis, but herteeth were distinctly syphilis, although careful inquiry failed to elicit porting this opinion. There was no history other possible cause of tabes dorsalis. State on Examnination.-Her intelligence is normal; headache, and sleeps well. The pupils are equal, medium, light, well on convergence. There is some impairment In ears. No other cranial nerve affection. The muscles limbs re strong, but she shows a marked degree of muscular is distinctly ataxic. Sensation.-Tactile sensation is blunted over the outer side and on the sole. Th-s area of upwards a shiort distance on the leg; over foot there is only a slight blunting of tactile is impaired over the left leg and foot; she always tween 'thehead and point of a pin, and the delayed. She cannot tell when she is pricked at two 'O simutaneously on the foot, even when these points are over two inches apart. sensation is dulled and delayed over the same area. Mtuscular Sense.-She can touoh the tip of the no3e with fair degree of precision with the eyes closed, position of lher fingers when passively moved. She describe this symptom found; the hands alone were studied. Byrom Bramwell, recent article in Brain, on an analysis of 155 cases tabes,
doi:10.1136/bmj.1.2197.297 fatcat:d7v5qbyskfbdzjycmzscyq3yxm