Another symptom denoting paresis of the cranial nerve-centres is a
marked change in the expression of the face. The features become
relaxed, and lose their mimetic play. The cornea is dull, and, together
with the anterior surface of the eyeball, becomes dry, as the eyelids
are moved imperfectly, if at all, and the tears in consequence are not
properly distributed over the conjunctiva. The nostrils become more or
less immovable, and the naso-labial fold is obliterated, whilst the
lower lip hangs down. The lips are apart, as the lower jaw is not held
up by the muscles. When paralysis supervenes it drops entirely, and the
tongue protrudes.
Deglutition, somewhat difficult in paresis, is completely suspended in
the paralytic stage, through paralysis of the soft palate, the pharynx,
and oesophagus. Liquids forced on the patient in this extremity may
partly flow down the oesophagus, but will also enter the larynx, and
their administration should be carefully avoided.
D. Action on motor-centres of Cerebellum and Basal Ganglia.
Of this action little if anything is patent to observation. A certain
want of co-ordination in the movements has been noticed in the early
stage of paresis, and the peculiar staggering walk of persons in this
stage is probably owing to an affection of the motor-centres of the
cerebellum. That they do not escape the action of the subtle poison,
when symptoms denoting the invasion of all the other motor-centres
throughout the body are in evidence, we have every reason to assume.
The co-ordination and automatic regulation of the lower motor-centres
must necessarily escape observation when the function of these centres
is partially suspended, and when, moreover, the powerful currents of
nerve force the cerebellum and basal ganglia receive from the motor
cortical centres of the cerebrum are partially if not wholly withdrawn.
E. Action of the Motor Cortical Centres of the Cerebrum.
Public-domain text, read in full here on John Shaqi.
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