Prognosis. — Except in the syphiltic cases, the prognosis is bad. The duration of the disease is extremely variable. It is essentially slew, however, in progress, and often many years elapse before the victim succumbs. Paralytic helplessness may develop, however, within a few years and become complete. When mental symptoms are manifest early in the dis ease the prognosis is proportionally worse.
Treatment.—Potassium iodide should be invariably tried in this disease. No harm can result, and the patient is given the benefit of the possibility that syphilis may be the cause.
Syringomyelia.
Definition.—The term etymologically signifies a cavity (abnormal) within the substance of the spinal cord. Such a literal and limited definition is, however, inaccurate and misleading. By almost general consent the word has been re stricted in its application to a disease characterized anatomically by lesion usu ally and chiefly of the central substance of the cord; pathologically by a gliosis or gliomatosis dependent upon embry onal-tissue persistence, with subsequent perverted cellular proliferation and ulti mate cavity-formation; clinically by the presence, in association, of progressive muscular atrophy, dissociation of sensa tion, prominent trophic symptoms, and scoliosis.
Symptoms. — The clinical picture in syringomyelia- is exceedingly variable, as may be inferred from the morbid anat omy. There is not a function of the cord which may not be perverted, and, on the other hand, no disturbance at all may be present or at least recognized. There is no single pathognomonic symp tom, nor is there any constant grouping of symptoms which is positively charac teristic of the disease. The attempt has been made to classify the disease into clinical subtypes according to the local ' ity first or most affected or the predom inance of motor, sensory, or trophic symptoms. Such subdivisions are ob viously of but little value. In the very small number of cases in which the diag nosis has been made during life and con firmed by autopsy the clinical history has been about as follows: The patient first notices some aching and pain in the neck, shoulders, and arms, with parms theshB in the hands and fingers. This is followed by an atrophy which slowly affects, first, the smaller muscles of the fingers and hand, and which is attended with fibrillary twitches. Analgesia de
velops in varying degree in the affected limb, and thermo-anTsthesia, sometimes complete, is also present. Tactile per ception may remain either normal or only slightly impaired, and this combination of analgesia with thermo-amesthesia and preserved tactile perception constitutes the so-called dissociation of sensation at one time erroneously supposed to be pathognomonic of syringomyelia. Fol lowing the atrophy and sensory disturb ances, trophic lesions of the skin, hair, nails, bones, etc., develop, and are often quite prominent. lIerpes, bulise, ulcers, felons, and gangrene, usually painless, are among the skin lesions observed. Extensive arthropathies have been noted, and the bones may become quite brittle. Vasomotor symptoms—such as sweating, oedema, redness, or cyanotic discoloration in certain areas or a limb—are quite com mon. As the disease extends from above downward, the trunk-muscles become involved, and scoliosis, or curvature, de velops. Extending still lower, the legs are affected with paraplegic weakness, the sphincters become paralyzed, and sexual power is lost. Just as with the upper, the first symptoms indicating in volvement of the lower cord may be irri tative—parmsthesim may precede the paraplegia. Should the disease extend upward, bulbar symptoms are added. The trigeminus may be affected and facial atrophy appear. Papillary ab normalities have been noted occasion ally, particularly an inequality in size and response. The eyeball may ap pear protuberant as in exophthalmic goitre, or the globe may appear to have receded, with narrowing of the interlid space. This condition is often asso ciated with facial hemiatrophy (Schulte).
Ataxia of both lower and upper ex tremities has been observed. The cular sense, however, may remain nor mal.
The symptoms are usually bilateral, though they may at first and for some time be limited to one side, and they are often unequal in degree on the two sides. The first symptom may be able to the dorso-lumbar or the bulbar segments, in which case, of course, the order of sequence would be reversed.