A system of practical medicine. By American authors. Vol. 5 : $b Diseases of the nervous system
Science
A system of practical medicine. By American authors. Vol. 5 : $b Diseases of the nervous system
Medicine -- Practice
Negative Characters.—Absence of typical hemiplegic or monoplegic
distribution of symptoms. Rarity of head symptoms, as headache,
vertigo, mental disturbance; of lesions of the optic nerve. Absence of
epileptiform convulsions. Absence of such grouping of motor and
sensory symptoms as would exactly correspond to the area of
distribution of one or more large nerve-trunks.
The above symptomatic indications are, of course, of the most general
meaning only, and are liable to exceptions and subject to varying
conditions.
The DIAGNOSIS of the exact localization of lesions in the spinal cord,
considered from the clinical standpoint, is perhaps best arrived at by
following an anatomical and physiological order of subdivision of the
problem into three questions, as follows:
FIRST QUESTION.—BEING GIVEN SYMPTOMS INDICATING DISEASE LIMITED TO ONE
OR MORE SYSTEMS OF THE SPINAL CORD, TO DECIDE WHICH ARE AFFECTED.
Physiology and the results of embryological and pathological
researches justify us in making a general division of the spinal cord,
for purposes of diagnosis, into two great systems, whose limits are
fairly well known—viz. the æsthesodic or sensory system, and the
kinesodic or motor system. The following outline diagram (Fig. 5) of
section through the spinal cord exhibits the ascertained limits of the
two systems.
[Illustration: FIG. 5. Diagram of a Transverse Section of the Spinal
Cord through the Cervical Enlargement: The æsthesodic system is
shaded, the kinesodic system unshaded. Parts of the æsthesodic system:
(1) Posterior nerve-roots; (2) posterior gray horns; (3) fasciculi
cuneati (columns of Burdach, inclusive of posterior root-zones); (4)
fasciculi graciles (columns of Goll or posterior median columns); (5)
ascending cerebellar fasciculi; (6) columns of Clarke. Parts of the
kinesodic system: (7) Anterior roots; (8) anterior columns (inclusive
of anterior root-zones); (9) anterior gray horns; (10) crossed
pyramidal fasciculi; (11) direct pyramidal fasciculi (columns of
Türck); [10 and 11 are the intraspinal prolongation of the cerebral
motor tract]; (12) lateral columns, of ill-defined limits and unknown
functions; P. R., posterior roots; P. S., posterior septum; A. R.,
anterior roots; A. F., anterior fissure.]
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