Neurological Retrospect

New Type of Crossed Hemiplegia.—In the Nouvelle Iconographie de la Salpêtrière for May and June of last year, Dr. Anna Goukovsky, of Odessa, describes under this title a very interesting case of paralysis with wasting of one side of the tongue accompanied by paralysis of the opposite side of the body except the face. The combination must be an exceedingly rare one, although it is perhaps a pity to multiply types and not to regard the symptoms as simply determined by a somewhat unusual site of the lesion and its limited character. The patient was a man of 60 without anything significant in his family or personal history. There was no evidence of an attack of syphilis. On 1st December, 1893, at 10 a.m., he suddenly felt unwell, and this feeling was soon followed by vertigo and sickness. He did not entirely lose consciousness. Twenty minutes later it was found that he had lost the use of his right arm and leg, but the face was unaffected. There was no aphasia, but there was some difficulty of articulation. On examination later it was found that the left half of the tongue was wasted and was the seat of fibrillary contractions, and that on protrusion it deviated distinctly to the left side. The two sides of the face were unaltered and similar in appearance, and the arm and leg on the right side were paralysed and contracted. The reflexes were exaggerated, but the rigidity on the right side prevented them from being easily elicited. There was no albuminuria. There was a gradual failure of strength and of intellectual capacity, trophic disturbances developed, and the patient succumbed about 12 weeks after the first onset of the symptoms. At the necropsy the important changes were those found in the medulla oblongata. The posterior aspect of this presented nothing unusual except that the left half was smaller than the right. On the anterior aspect there was evident great diminution in the size of the left half as compared with the right, and the part of the pyramid on the left side at the inferior part of the olive was distinctly atrophied. The pia mater over these was distinctly hyperæmic and underneath there seemed to be fluctuation. The roots of the twelfth nerve on the left side were thin and small compared with those of the right, and the arteries at the base presented changes resulting from chronic arteritis deformens. Further examination revealed the existence in the bulb of a patch of degeneration in the region of the left olive. This structure itself was almost entirely destroyed, and the process which had caused this had involved also the roots of the hypoglossal nerve. There was in the cord the usual descending degeneration, and the lesion in the region of the left olive was apparently the result of changes in the vessels and consequent blocking, complete or partial, of these. The case is very interesting as affording clinically an example of a rare combination of symptoms, a combination, however, which the situation of the lesion adequately explains.