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
When these cortical areas are destroyed by disease, or when their
connected fasciculi are severed, secondary degeneration takes place
and extends to the end of the respective bundles, even to the lower
extremity of the spinal cord.
Before leaving the subject of the composition of the kinesodic system
it is desirable to add a few words concerning the decussation of the
pyramids or distribution of the pyramidal tract in the spinal cord. As
is well known, this is double, a small part of the pyramidal bundle
remaining on the same side of the median line, the so-called direct
pyramidal fasciculus or column of Türck (Fig. 5, No. 11) forming the
mesal edge of the anterior column of the cord. The larger part of the
pyramid crosses the median line at the decussation, and enters the
opposite lateral half of the cord, in which it is found as the crossed
pyramidal fasciculus (Fig. 5, No. 10) in the posterior part of the
lateral column, rapidly diminishing in size in the dorso-lumbar part
of the cord. The {88} important point to bear in mind for the study of
monoplegias and of hemiplegia is that the amount of decussation is far
from uniform. This variability was first demonstrated by Flechsig.[14]
He found in a series of sixty fœtuses such variations in the relation
of the crossed and direct fasciculi as 100:0 (complete decussation),
92:8, 84:16, 70:30, 52:48 (nearly semi-decussation, producing equal
fasciculi), 35:65, 10:90 (almost non-decussation).
[Footnote 14: _Die Leitungsbahnen im Gehirn und Rückenmark des
Menschen_, Leipzig, 1876.]
It should also be added that quite certainly the cerebellum, nucleus
caudatus, nucleus lentiformis, and nucleus pontis form parts of the
complete kinesodic system, but we are as yet ignorant of their exact
connections and functions.
With respect to the anterior part of the frontal lobe, forward of the
oblique line A B across Figs. 10 and 11, the study of human cases of
destructive injury and disease would indicate that it is not
associated either with the kinesodic or with the æsthesodic systems.
The SYMPTOMS of lesions of the kinesodic system, particularly of the
pyramidal tract, are exclusively motor, consisting of spasm and
paralysis. Contracture of the paralyzed parts follows the paralysis
after a few weeks if the lesion be a destructive one.
Clinically, the following DIAGNOSES of localization of lesions in this
system are now possible:
(_a_) Lesion of the speech-centre (4) and of its associated white
fasciculus is indicated by intermittent or constant aphasia of the
motor form, with or without paralysis of the face and limbs (on right
side usually).
(_b_) Lesion of the facial centre (1) and of its associated fasciculus
is characterized by the occurrence of spasm or paralysis, or of both
in rapid succession, in the facial muscles; their electrical reactions
remaining normal.
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