Two cases of acute endocarditis / by John Cowan [and others].

Date:
[1910]
Catalogue details

Licence: In copyright

Credit: Two cases of acute endocarditis / by John Cowan [and others]. Source: Wellcome Collection.

Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.

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    where it was involved by lesions of the kind which we have described : (1) a case of cardio-sclerosis with ' nodal' rhythm for two months before death ; the a.-v, node and bundle were affected; (2) a mitral case, with attacks of paroxysmal tachycardia ; here the sino-auricular node was involved as well as the a.-v. node and bundle. Schonberg reports five cases of persistent irregularity of the heart in which the sino-auricular node was affected : the a.-v. bundle and node were not examined. Vaquez reports a case of paroxysmal tachycardia in which the sino-auricular and a.-v. nodes and the a.-v. bundle were involved. The sensory disturbance in the left leg raises a question of great interest, for the only lesion found in the central nervous system was confined to the left cerebral hemisphere. The sensory disturbance was noticed on July 15th, 16th, and 17th, but could not be followed after the 19th on account of the mental disturbance produced by the second embolus. The area involved was diminishing on the 17th. It is, of course, well known that unilateral cerebral lesions produce relative weakness of the muscles on the same side as the lesion, as well as palsy on the opposite side, but there are few cases on record of bilateral sensory loss. A recent paper by G. Bergmark contains, however, four cases, two of which were observed by himself. His first case was a man aged 66, who developed a right hemiplegia on March 6. Two days later there was complete right hemianaesthesia and ' marked hypalgesia of the left lower extremity', which had disappeared three weeks later. His second case, a man aged 74, developed a left hemiplegia in September; when examined four months later, the right leg below the knee and the distal phalanges of the right finger were insensitive to cotton-wool touch. Post-mortem examination revealed an extensive lesion occupying almost the whole of the internal capsule, the greater part of the lenticular nucleus, and the external and lower portions of the optic thalamus. He quotes two cases, recorded by Freidrich Miiller, with hypalgesia in the distal part of the lower extremity on the non-paralysed side. The cause of the bilateral loss is somewhat obscure. Bergmark rejects the obvious theory of bilateral innervation proposed by Miiller, as he found that in his first case defective sensation in the mesial parts of the trunk on the non- paralysed side disappeared rapidly, while that in the legs lasted for longer and disappeared simultaneously. He thinks that a more plausible explanation can be found by assuming a double cerebral lesion, that in the ' healthy ' hemi- sphere being relatively slight and transient, and the result of the disturbance of the cerebral blood supply. The rarity of bilateral sensory disturbances is probably more apparent than real, for it is but seldom that sensation can be accurately tested immediately after the occurrence of a cerebral lesion, as the disturbance of cerebral function commonly affects the intelligence of the patient and affords obvious sources of inaccuracy ; and the sensory loss is often transient.