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
(_α_) Lesions involving the meso-ventral aspect of one crus cerebri.
The direct symptoms of such a lesion are in the range of distribution
of the motor oculi (N. iii.), such as ptosis, mydriasis, external
strabismus, and heteronymous diplopia; the crossed symptoms are more
or less complete paralysis of the lower part of the face and of the
extremities on the opposite side (hemiplegia). This relatively
frequent form of crossed paralysis we designate as the eye-and-body
type.
(_β_) The lesion occupies the latero-ventral part of the crus. This
rare localization would give rise to direct paralysis of the fourth
nerve, indicated by homonymous diplopia in the lower inner field of
vision; to lateral hemianopsia with dark half-fields opposite the
lesion, from injury to the tractus opticus (vide Fig. 8); and to a
mixed motor and sensory disturbance in the opposite side of the face
and body, without anæsthesia of the olfactory and auditory apparatus.
A very large lesion involving almost the entire crus would probably
also cause direct paralysis of N. iii.
(_γ_) Lesion of the basal part of the pons frontad of an imaginary
transverse line passing through the apparent origin of the trigemini
(NN. v.). Symptoms: A common hemiplegia of the lower face and
extremities on the opposite side with neuro-retinitis and other
general signs of basal disease. The abducens nerve (N. vi.) would in
some cases be involved in its course frontad over the pons, giving
rise to internal strabismus and homonymous diplopia on the same side
as the lesion.
(_δ_) A focal lesion in the caudo-ventral part of the pons—_i.e._
caudad of an imaginary transverse line passing through the trigeminus
roots—gives rise to highly characteristic symptoms. These are: Direct
paralysis of the face, not (?) affecting all the muscles, but without
De R., and common hemiplegia of the limbs on the opposite side.
If the lesion be strictly basal—_i.e._ one springing from the
membranes or bone, the trunks of the sixth and seventh (facial) nerves
are directly injured, and the resulting facial paralysis is of the
peripheral form, affecting all the muscles and yielding De R. The body
symptoms on the side opposite the lesion are less marked.
In the first category of cases, those in which the lesion is in the
substance of the pons, the motor fasciculus from the cortex cerebri to
the nucleus of N. vii. is injured caudad of (below) its theoretical
decussation-point on the middle part of the pons, while the pyramidal
tract is involved frontad of (above) its decussation.
This symptom-group is known as face-and-body type, or as crossed
hemiplegia, strictly speaking.
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