THE TREATMENT OF TUBERCULOSIS OF THE LARYNX
Authors: R. S. Stevenson
Journal: BMJ (1933)

I MEDICAL JOURNAL~~~~t hough later on the spasticity increased, the plantars became bilaterally extensor, with some ataxic nystagmus and some wasting of the extensors in the thigh.The injury appears to have produced some damage, possibly in the spinal cord, damaging his right leg, but beyond that there is a progressive element of nervous disease as shown by the nystagmus and the fibrillary tremor and wasting of the extensor muscles in the right thigh.The absence of anaesthesia and sphincter symptoms might suggest, in view of the wasting and fibrillary tremors, amyotrophic lateral sclerosis, though the ataxic nystagmus is more in favour of disseminated sclerosis.In any case, a progressive nervous disease follhwing immediately upon severe concussion of the spine is evident.A point in favour of the disease being really disseminated sclerosis may be taken to be the presence of trigeminal neuralgia, and, seeing that this had commenced two years before his injury, it is quite possible, if not probable, that dis- seminated sclerosis was lying latent and was aggravated definitely by the injury.Case 15.-An interesting case because of its early com- mencement-was that of a man whom I saw in 1920, aged nearly 23.When 8 years old, for three months he suffered with incoordination of both his hands and loss of sensation.He never walked well in the dark, but he was a fair long-distance runner as a boy.Diplopia was first observed when he was 15 years old, but he had no weakness of his legs until three months before I saw him, and five months previously to commencement of the weakness of his legs he had had a bad fall from a horse, and shortly before that a severe blow on his head.On examination he was a typical case of disseminated sclerosis, ataxic, with bilateral extensor plantars, bladder incontinence, and nystagmus, especially to the right.It seems probable that the two severe blows that he had a few months before the onset of the weakness of the legs aggravated the existing disease and caused it to progress more rapidly.Case 16.-Another case of trigeminal neuralgia complicating chronic spinal sclerosis I saw in a man, aged 49, who had had a severe fall when bicycle racing, being badly concussed and unconscious for several days.He was laid up for some weeks after this, and his right leg never became quite right again.Five years later he had a fall when out shooting, causing numbness of the legs, which were paralysed for an hour.The case was mistaken for a pressure paraplegia as a result of the fall, and laminectomy was done, and seven years later trigeminal neuralgia commenced.When I saw him he was very spastic and ataxic, with extensor plantars and absence of abdominal reflexes.The case appears clearly to be one of a chronic spinal sclerosis, possibly disseminated sclerosis, developing as a sequel of severe spinal and cerebral concussions.Case 17.-A case I saw at St. Mary's in 1919-a man of 36, who, when aged 22, was struck on the head by a falling log of wood, and was unconscious for a quarter of an hour.From then onwards he complained of sensations of weight on the top of his head, though he kept at work for eighteen months.Then one night he had a " stroke,'' his left arm and leg being paralysed for ,weeks, and his face drawn over.In two months' time he was better, and was able~to return to his work for three months at the time, when the weakness would return, either on the right side or left, accompanied by sphincter trouble.On examination I found spastic para- plegia, with some ataxy of his hands, well-marked nystagmus, extensor plantar reflexes, and ankle-clonus.This case was clearly one of disseminated sclerosis, which appears to have had its origin in the blow upon the head three years previously.In addition to these cases I-have notes of six more hospital cases in which the symptoms in disseminated sclerosis appeared to follow directly after injury, but it is, I think, unnecessary further to labour this point.