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
1. SYSTEMATIC LESIONS OF THE ÆSTHESODIC SYSTEM OF THE ENCEPHALON.—The
limits of this system are as follows: Within the oblongata and pons it
occupies a somewhat uncertain (from a clinical standpoint) location,
its fasciculi and ganglia lying in a general way dorso-laterad of the
motor or kinesodic system. In the crus cerebri the fibres of the
sensory tract are more closely packed together, and constitute a dense
fasciculus of white substance in the lateral part of the crus in its
subcerebral extremity, estimated by Flechsig at about one-fifth of the
entire crus, and thence it enters into the composition of what is
known as the internal capsule. This narrow but all-important mass of
{82} white fibres, as revealed by a horizontal section of the
hemisphere (vide Fig. 7), lies between the nucleus caudatus and the
nucleus lentiformis, and between the latter and the thalamus, thus
assuming a V or elbow shape. Of this, the caudal third of that part of
the capsule behind the bend or angle contains all the sensory paths
for the opposite half of the body, reinforced by paths for the special
senses; it is the carrefour sensitif of French writers. From this
region sensory fasciculi radiate to various parts of the cerebral
cortex—in the parietal, temporal, and occipital gyri—in which
physiological experiments and human cases of disease have shown
sensory areas or centres. Of the fasciculi from special sense-organs
which reinforce the internal capsule, the only one which is well
defined and easily traceable is the fasciculus opticus (fasciculus of
Gratiolet), derived in part directly from the optic tract of the same
side and from the primary optic centres (lobus opticus, corpus
geniculatum laterale, and pulvinar), proceeds, along with fibres of
the internal capsule, dorso-laterad of the posterior cornu of the
lateral ventricle, to the mesal aspect of the occipital lobe. A
fasciculus from the olfactory apparatus doubtless also joins the
internal capsule, but its course is unknown.
The following localization diagnoses are now possible in the
æsthesodic system as above defined:
(_a_) A lesion of the internal capsule, just above the crus cerebri,
involving its bend or knee and caudal segment, with or without injury
to the nucleus lentiformis and thalamus, will give rise to the
following symptoms: Complete typical hemiplegia and total
hemianæsthesia on the opposite side of the body; the anæsthesia
involves the special senses as well as the body. Vision is, however,
unaffected, unless the lesion extend far enough back to involve the
pulvinar and fasciculus opticus, when lateral hemianopsia occurs (dark
half-fields on the side opposite the lesion). When this lesion is in
the left hemisphere, sensory aphasia also occurs.
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