Palsy of the extraocular muscles in exophthalmic goitre : with the report of a case / by William Campbell Posey.

  • Posey, William Campbell, 1866-1934.
Date:
[1904]
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Credit: Palsy of the extraocular muscles in exophthalmic goitre : with the report of a case / by William Campbell Posey. Source: Wellcome Collection.

Provider: This material has been provided by UCL Library Services. The original may be consulted at UCL (University College London)

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    Vossius1 of cases of paralysis of convergence. Palsy of the levator palpebral superioris in conjunction with palsy of the other branches of the third nerve is rare; but is rather more common without such association. The palsy may come on early in the course of the dis- ease, but in most cases it is a late manifestation; though usually persistent, it may be but a transient condition, the muscles regaining their full strength. The palsy may occur without paralysis of other cranial nerves, or it may be associated with a similar affection of one or more of them; thus Bristowe2 has recorded the case of a young man who developed the symptoms of ophthalmoplegia externa three years after the ordinary symptoms of Graves' disease had manifested themselves. There was also right hemiansesthesia, with color blindness and loss of taste and smell on the same side, some palpita- tion and dyspnoea with headache and sickness. After a period of some months, epileptic fits came on, and later on hemorrhages from both ears. Death finally occurred from bronchitis. Autopsy was negative. Similarly in a case reported by Warner3 there was binocular external ophthalmoplegia with palsy of the facial and trigeminal nerves. Jendrassik4 saw paresis of the muscles of mastication in addition to palsy of the rotary muscles of both globes, as well as most of the muscles of the face and palate. Of interest in this connection also are four cases reported by Ballet:5 the first, the subject of severe hysteria, in addition to ophthalmoplegia externa, presented a number of bulbar symptoms—i. e., palsy of both facials and paresis of the hypoglossus. In the second, also the subject of severe hysteria, there was right-sided hemiansesthesia and loss of smell and taste on the same side. Autopsy showed no visible change in the central nervous system. In a third case, in addition to palsy of both external rectus muscles, there was right- sided hemiplegia and hemiansesthesia, with epileptic attacks. The fourth case was an instance of ophthalmoplegia externa with paresis of the facial and hypoglossus. Chevalier6 saw palsy of the externi and oblique muscles associated with disturbance in the supply of the fifth and seventh nerves and of speech. In a case of Maude's7 the lesion seemed to spread over the entire region of the nuclei of the extraocular muscles, and those neighboring upon them, paresis of the external rectus, and probably of the superior oblique, being preceded by palsy of the facial and quickly followed by general ophthalmoplegia. Stellwag's8 case was one of paralysis of the lateral rotators (the 1 Beitriige zur Augenheilkunde, 1895, vol. xvill. * Brain, 1886, p. 818. » Medical Times and Gazette, 1882, p. 540. « Arch. f. Psych., 1886, yol. xvil. p. 801. 6 Loc. clt. • Thesis, Montpelller, 1891. ' St. Bartholomew's Hospital Reports, 1892, vol. xxvll.; also Brain, 1892. Autumn, p. 424. ' Wien. med. Jabrb., 1869, p. 25.