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
(_b_) Lesions of the fasciculi graciles (column of Goll, 4) cannot, we
believe, be recognized directly by positive symptoms. There are a few
cases on record of primary (?) sclerosis of these columns, in which
during life vague sensory symptoms had been noted, but we cannot build
upon such data. Indirectly, however, we can in many cases
diagnosticate degeneration of these fasciculi, reasoning from the data
of pathological anatomy. Thus, for example, in advanced cases of
sclerosis of the fasciculi cuneati (posterior spinal sclerosis) we
know that in the dorsal and cervical regions of the cord the columns
of Goll are in a state of secondary degeneration. After complete
transverse division of the cord by injury, extreme pressure, or focus
of myelitis, etc. the same (centripetal) degeneration exists above the
lesion.
The same remarks apply fairly to our clinical knowledge of the
remaining parts of the æsthesodic system, columns of Clarke (6), and
fasciculi ad cerebellum (5). We know absolutely nothing of lesions of
the posterior horns (2) in their clinical and diagnostic relations.
B. Lesions of the Kinesodic System.—Limits of the Kinesodic System.—In
general this includes the antero-lateral parts of the cord. In a
trans-section of the cord (vide Figs. 5 and 6) the following columns
and fasciculi are recognized, their location and limits being made
known to us by embryology, descriptive and pathological anatomy: (7)
The anterior (ventral) nerve-roots emerging from (8) the true anterior
columns or anterior root-zones; (9) the ventral (anterior) gray horns
with their groups of ganglion cells; (10) the crossed pyramidal
fasciculus, which is the caudal continuation of the cerebral motor
tract of the opposite hemisphere; (11) the direct pyramidal column
(column of Türck), which is the caudal continuation of the cerebral
motor part of the hemisphere on the same side; (12) the antero-lateral
column. Fasciculi 10 and 11 bear an inverse relation to each
other—_i.e._ 11 is larger in proportion as 10 is smaller.
[Illustration: FIG. 6. Diagram of a Transverse Section of the Spinal
Cord through the Lumbar 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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