File:Diseases of the nervous system (1908) (14779387062).jpg

Identifier: diseasesofnervo00chur (find matches)
Title: Diseases of the nervous system ..
Year: 1908 (1900s)
Authors: Church, Archibald, b. 1861, ed Salinger, Julius L. (Julius Lincoln), tr
Subjects: Nervous system
Publisher: New York and London : D. Appleton and company
Contributing Library: The Library of Congress
Digitizing Sponsor: The Library of Congress

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d there was only asmall hypesthetic zone aroundthe anus. If, in this manner, we at-tempt to diagnosticate a tumorwith certainty or even likeli-hood, we must also ascertainwhether its location is extra-dural or intradiiral; and, ifthe latter, whether it lies be-tween the pia and dura, orbetween the pia and the spinalcord. Fortunately the latteris very rare. I say fortunately,because in this case the differ-entiation between acute trans-verse myelitis and pressurefrom tumor can scarcely bemade; for, on the one hand,there are few sensory irritativephenomena, and, on the other,a general inhibition of conduc-tion, an interruption withinthe spinal cord, very rapidlytakes place. We are still unable to dif-ferentiate between extraduraland intradural tumors, al-though great attention hasbeen devoted to this distinc-tion. Nor can we determine(important as this may be indeciding the question of oper-ation for tumor) whether aFig. 160.—Sarcoma of the Cauda Equina. tumor grows anteriorly or pos-
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THE SEAT, EXTENSION AND COMPOSITION 367 teriorly, or presses upon the sijinal cord. We might suppose that in posteriorpressure irritative phenomena and radiating pains would from the onset pre-dominate, and that in anterior pressure these might be absent or only slight.But this is by no means always the case. I have been convinced that, evenwith posterior pressure, the initial and neuralgic stage of the disease or painmay be almost wholly absent. It is easier to determine that a tumor grows laterally, or (at least chiefly)from one side. This for a time produces the familiar picture of semi-lesion, or Brown-Sequards paralysis; i. e., motor paralysis predominates onthat side of the spinal cord in which there is most marked pressure, onthe other sensory paralysis, especially involving the pain and temperaturesensations. Furthermore it is important to demonstrate whether the cause of com-pression is disease of the vertebral column or not; above all, whether tuber-culosis is present. This

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