It is now generally recognized that the disease known as locomotor
ataxia may include among its clinical manifestations symptoms other than
those which depend on pathological changes in the spinal cord. A number
of these are associated with the functions of the eyeballs. The
Argyll-Robertson pupil is universally admitted as valuable confirmatory
evidence of a diagnosis of locomotor ataxia; ocular paralyses, if less
frequent, are certainly not less significant; and optic nerve atrophy is
at least so well known in connection with the disease that its
occurrence in any individual case would hardly call for comment.
A further step forward in our knowledge of the clinical possibilities of
locomotor ataxia has been the recognition of the fact that ocular
disturbances may precede the evidences of any spinal lesion. This
advance necessarily means that the occurrence of any one of the ocular
events above mentioned must, unless otherwise explained, generate the
suspicion that the case may in its later events display the phenomena
known to depend upon sclerosis of the posterior columns of the spinal
cord.
It is very difficult to collect the evidence necessary to show in what
proportion of cases this suspicion is justified by the event. For it is
certain that ocular disturbances may long precede the manifestation of
spinal symptoms. In the case of optic atrophy the interval may,
according to Gowers, extend even to twenty years. Thus it can only be in
very exceptional instances that one and the same physician will have the
opportunity of observing at least a number of these cases through all
the stages of their progress. Yet, if true, it is of manifest
importance, for the sake both of exact knowledge and of accurate
prognosis, that it should be clearly recognized that an optic-nerve
atrophy, an ocular paralysis, or a loss of the pupil light reflex,
unless capable of other explanation, belongs in all probability to the
order of events incident to locomotor ataxia, and that any one of these
may well be the introduction to a more widely-spread manifestation of
the disease.
For reasons stated above, the collection of complete histories necessary
to afford actual demonstration of the truth of these propositions is
difficult; and all the more so as there is reason to believe that in
those cases in which the early stress of the disease falls upon the
nervous apparatus of the eyeball the spinal symptoms are apt to be
slight in degree as well as delayed in development. This is certainly
the case when the ocular disturbance takes the form of optic-nerve
atrophy. “In a large number of such cases,” says Gowers, “ataxy never
comes on, the spinal malady becoming stationary when the nerve suffers.”
Public-domain text, read in full here on John Shaqi.
Reviews
Reviews
No reviews yet
Be the first to share your thoughts on this work.
Join the Discussion
Join the discussion
Sign in to leave a comment or review.
Sign InorCreate an account